Provider Demographics
NPI:1073569422
Name:LA HAYE, BARBARA JANE (RN)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:JANE
Last Name:LA HAYE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 WESTSIDE AVE
Mailing Address - Street 2:UNIT 12
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-1308
Mailing Address - Country:US
Mailing Address - Phone:262-363-5244
Mailing Address - Fax:
Practice Address - Street 1:331 WESTSIDE AVE
Practice Address - Street 2:UNIT 12
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-1308
Practice Address - Country:US
Practice Address - Phone:262-363-5244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43084030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39976700Medicaid