Healthcare Provider Details

I. General information

NPI: 1982966800
Provider Name (Legal Business Name): SUSAN L HAYES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 06/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12080 MARSTON ST
CLINTON LA
70722-3217
US

IV. Provider business mailing address

12080 MARSTON ST
CLINTON LA
70722-3217
US

V. Phone/Fax

Practice location:
  • Phone: 225-683-8551
  • Fax: 225-683-3788
Mailing address:
  • Phone: 225-683-8551
  • Fax: 225-683-3788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number086824
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: