MEDICARE: SUSAN HAYES DNP, FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APN.0992689-NP	CO

General Provider Information

NPI Number	:	1063964096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN HAYES DNP, FNP

Provider Business Mailing Address
First Line	:	1450 DEXTER ST
Second Line	:
City	:	FORT LUPTON
State	:	CO
Zip	:	80621-1503
Country	:	US
Telephone Number	:	303-857-2087
Fax Number	:

Provider Business Practice Location Address
First Line	:	1450 DEXTER ST
Second Line	:
City	:	FORT LUPTON
State	:	CO
Zip	:	80621-1503
Country	:	US
Telephone Number	:	303-857-2087
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2016
Last Update Date	:	10/27/2016

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