Clifford Lee Hazelwood
Nurse Anesthetist, Certified Registered in Hodgenville, KY. Individual provider (NPI-1).
NPI number1689340374
StatusActive
Last updated in NPPESJan 6, 2023
Details
- NPI
- 1689340374
- Entity type
- Individual (NPI-1)
- Name
- Clifford Lee Hazelwood
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Aug 21, 2021
- Certification date
- Jan 6, 2023
- Last updated
- Jan 6, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | 3017161 | KY | Yes |
| 163W00000X | Registered Nurse | 1092982 | KY |
Practice location
4470 Bardstown RdHodgenville, KY 42748-9313
Phone 270-763-3313
Mailing address
4470 Bardstown RdHodgenville, KY 42748-9313
Phone 270-786-3313
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