Individual
NANCY HAZEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
308 RIO LUCERO RD, EL PRADO, NM 87529-9507
(505) 758-1494
Mailing address
HC 74 BOX 20709, EL PRADO, NM 87529-9507
(505) 758-1494
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
0414
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00JD84
BCBS PROVIDER NUMBER
NM
05
—
G7297
—
NM
01
—
NM102165
VALUE OPTIONS PROVIDER #
NM
Enumeration date
08/05/2006
Last updated
07/09/2007
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