Healthcare Provider Details

I. General information

NPI: 1760594881
Provider Name (Legal Business Name): DIANA HAYES CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 N STATE RD
OWOSSO MI
48867-9075
US

IV. Provider business mailing address

826 W KING ST PO BOX 456
OWOSSO MI
48867-2120
US

V. Phone/Fax

Practice location:
  • Phone: 989-743-3415
  • Fax: 989-743-6180
Mailing address:
  • Phone: 989-725-6528
  • Fax: 989-723-9446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704143423
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: