Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 783 | NM |
NPI | 1194716852 |
---|---|
Provider Name | Stephen H Hazen |
First Address | Santa Fe, NM 87507-5986 |
Second Address | Santa Fe, NM 87507-5986 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2005 |
Last Update Date | 08/07/2007 |