Provider Demographics
NPI:1003181330
Name:HAYES, LAWANA
Entity Type:Individual
Prefix:
First Name:LAWANA
Middle Name:
Last Name:HAYES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7684 STATE HIGHWAY 75 S TRLR 39
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-2704
Mailing Address - Country:US
Mailing Address - Phone:936-577-7559
Mailing Address - Fax:
Practice Address - Street 1:7684 STATE HIGHWAY 75 S TRLR 39
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-2704
Practice Address - Country:US
Practice Address - Phone:936-577-7559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor