Provider Demographics
NPI:1477192151
Name:HAYES, DEBRA SUSAN (FNP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:SUSAN
Last Name:HAYES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1399 S SALINE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CENTERPOINT
Mailing Address - State:IN
Mailing Address - Zip Code:47840-8217
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1399 S SALINE 4TH ST
Practice Address - Street 2:
Practice Address - City:CENTERPOINT
Practice Address - State:IN
Practice Address - Zip Code:47840-8217
Practice Address - Country:US
Practice Address - Phone:812-605-4887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-30
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71010040A207Q00000X
IN28195033A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine