Basic Information
| Provider Information | |||||||||
| NPI: | 1336770981 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAZEL | ||||||||
| FirstName: | SONYA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2192 | ||||||||
| Address2: | |||||||||
| City: | FORREST CITY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723362192 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702088362 | ||||||||
| FaxNumber: | 8702088384 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MARIANNA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723602102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702955280 | ||||||||
| FaxNumber: | 8702955390 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2020 | ||||||||
| LastUpdateDate: | 02/03/2020 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 02/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | R107031 | AR | Y | Nursing Service Providers | Registered Nurse |
No ID Information.