Healthcare Provider Details

I. General information

NPI: 1194063859
Provider Name (Legal Business Name): JACLYN JOAN HAYES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2013
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22119 480TH AVE
OSAGE MN
56570-9554
US

IV. Provider business mailing address

22119 480TH AVE P.O. BOX 306
OSAGE MN
56570-9554
US

V. Phone/Fax

Practice location:
  • Phone: 218-573-2238
  • Fax: 218-573-3778
Mailing address:
  • Phone: 218-573-2238
  • Fax: 218-573-3778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR189659-8
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: