Healthcare Provider Details

I. General information

NPI: 1356385124
Provider Name (Legal Business Name): LYNN ELLEN HAYDEN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PORTER DR SUITE 200
SAN RAMON CA
94583-1587
US

IV. Provider business mailing address

2185 PACHECO ST
CONCORD CA
94520-2309
US

V. Phone/Fax

Practice location:
  • Phone: 925-838-2108
  • Fax: 925-838-9265
Mailing address:
  • Phone: 925-676-0505
  • Fax: 925-676-2814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number200350029NPNMNP-PP
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number235648
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: