Provider Demographics
NPI:1114077823
Name:HAYTER, KATHRYN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:HAYTER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25664 LAHSER RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-5810
Mailing Address - Country:US
Mailing Address - Phone:248-358-7521
Mailing Address - Fax:248-358-7522
Practice Address - Street 1:25664 LAHSER RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-5810
Practice Address - Country:US
Practice Address - Phone:248-358-7521
Practice Address - Fax:248-358-7522
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704133284363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health