Provider Demographics
NPI:1013222736
Name:HAYTER, GREGORY JOHN (NP)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:JOHN
Last Name:HAYTER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1535 BERKELEY DR
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-1122
Mailing Address - Country:US
Mailing Address - Phone:517-484-5921
Mailing Address - Fax:517-483-7575
Practice Address - Street 1:1140 E MICHIGAN AVE STE 400
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1806
Practice Address - Country:US
Practice Address - Phone:517-364-9650
Practice Address - Fax:517-364-9605
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2019-09-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704190776363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health