MEDICARE: MRS. JENNIFER LYNN HAYES RN

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	163W00000X	Registered Nurse	RN 00145749	WA

General Provider Information

NPI Number	:	1790009751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER LYNN HAYES RN

Provider Business Mailing Address
First Line	:	22623 68TH AVE S
Second Line	:
City	:	KENT
State	:	WA
Zip	:	98032-1981
Country	:	US
Telephone Number	:	253-872-2121
Fax Number	:

Provider Business Practice Location Address
First Line	:	22623 68TH AVE S
Second Line	:
City	:	KENT
State	:	WA
Zip	:	98032-1981
Country	:	US
Telephone Number	:	253-872-2121
Fax Number	:

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

Provider Enumeration Date	:	03/19/2010
Last Update Date	:	03/19/2010

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