MEDICARE: MRS. BRIDGET DAVIS HAYES RN

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	163W00000X	Registered Nurse	100965	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649677469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRIDGET DAVIS HAYES RN

Provider Business Mailing Address
First Line	:	121 LAKE VIEW RIDGE DR
Second Line	:
City	:	LORIS
State	:	SC
Zip	:	29569-8833
Country	:	US
Telephone Number	:	843-756-6503
Fax Number	:	843-716-3501

Provider Business Practice Location Address
First Line	:	121 LAKE VIEW RIDGE DR
Second Line	:
City	:	LORIS
State	:	SC
Zip	:	29569-8833
Country	:	US
Telephone Number	:	843-756-6503
Fax Number	:	843-716-3501

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

Provider Enumeration Date	:	11/21/2014
Last Update Date	:	11/21/2014

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