MEDICARE: DEBRA L HAYES CFNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	041150128	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	CG5172	OTHER	IL	RR MEDICARE GROUP#
9	500011339	OTHER	IL	RR MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1942315197	OTHER	IL	NPI CLINIC NUMBER
2	0062839	OTHER	IL	UMWA
3	035446	OTHER	IL	HEALTH ALLIANCE
4	IL0115	OTHER	IL	JOHN DEERE
6	200397	OTHER	IL	BLACK LUNG
7	02922981	OTHER	IL	BCBS
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548378789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA L HAYES CFNP

Provider Business Mailing Address
First Line	:	180 S MAIN ST
Second Line	:
City	:	CANTON
State	:	IL
Zip	:	61520-2608
Country	:	US
Telephone Number	:	309-647-0201
Fax Number	:	309-649-5101

Provider Business Practice Location Address
First Line	:	601 E FORT ST
Second Line	:
City	:	FARMINGTON
State	:	IL
Zip	:	61531-1338
Country	:	US
Telephone Number	:	309-245-2406
Fax Number	:	309-649-6880

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2006
Last Update Date	:	04/18/2016

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