Healthcare Provider Details

I. General information

NPI: 1528167103
Provider Name (Legal Business Name): DEBRA J HAYDEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 10/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 MEADOWVIEW CTR SUITE 300
KANKAKEE IL
60901-2047
US

IV. Provider business mailing address

70 MEADOWVIEW CTR SUITE 300
KANKAKEE IL
60901-2047
US

V. Phone/Fax

Practice location:
  • Phone: 815-802-0022
  • Fax: 815-802-0011
Mailing address:
  • Phone: 815-802-0022
  • Fax: 815-802-0011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209-003859
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: