Provider Demographics
NPI:1265657860
Name:HAYES, STEPHANIE Y (LPN)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:Y
Last Name:HAYES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STEPHANIE Y HAYES
Mailing Address - Street 2:2360 SPORTSMAN CLUB RD
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-9579
Mailing Address - Country:US
Mailing Address - Phone:740-404-0492
Mailing Address - Fax:
Practice Address - Street 1:2360 SPORTSMAN CLUB RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-9579
Practice Address - Country:US
Practice Address - Phone:740-404-0492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN082922164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2089654Medicaid