Healthcare Provider Details

I. General information

NPI: 1104198977
Provider Name (Legal Business Name): MARGARET EVANS HAYDEN RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2012
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 MELVIN AVE
ANNAPOLIS MD
21401-1222
US

IV. Provider business mailing address

211 MELVIN AVE
ANNAPOLIS MD
21401-1222
US

V. Phone/Fax

Practice location:
  • Phone: 662-801-1326
  • Fax: 410-295-1291
Mailing address:
  • Phone: 662-801-1326
  • Fax: 410-295-1291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberR190488
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: