Basic Information
Provider Information
NPI: 1023382553
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HASON
FirstName: HARRIETTE
MiddleName: SIMS
NamePrefix: MS.
NameSuffix:  
Credential: RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 175 N GROESBECK HWY
Address2:  
City: MOUNT CLEMENS
State: MI
PostalCode: 480431562
CountryCode: US
TelephoneNumber: 5866270024
FaxNumber: 5866270027
Practice Location
Address1: 175 N GROESBECK HWY
Address2:  
City: MOUNT CLEMENS
State: MI
PostalCode: 480431562
CountryCode: US
TelephoneNumber: 5866270024
FaxNumber: 5866270027
Other Information
ProviderEnumerationDate: 03/01/2012
LastUpdateDate: 03/01/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000XRN4704204788MIY Nursing Service ProvidersRegistered Nurse 

No ID Information.


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