Provider Demographics
NPI:1396621611
Name:HAZEN-DIEHM, KEITH
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:HAZEN-DIEHM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 E 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-4203
Mailing Address - Country:US
Mailing Address - Phone:503-801-4323
Mailing Address - Fax:
Practice Address - Street 1:875 E 32ND AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-4203
Practice Address - Country:US
Practice Address - Phone:503-801-4323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202007308RN163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health