Provider Demographics
NPI:1487831491
Name:HAYS, OLENA NIKONOVNA (PA)
Entity Type:Individual
Prefix:
First Name:OLENA
Middle Name:NIKONOVNA
Last Name:HAYS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4418 STOCKBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95842-3347
Mailing Address - Country:US
Mailing Address - Phone:916-202-1094
Mailing Address - Fax:
Practice Address - Street 1:7777 SUNRISE BLVD
Practice Address - Street 2:SUITE 2500
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-2300
Practice Address - Country:US
Practice Address - Phone:916-722-2227
Practice Address - Fax:877-860-5422
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19547363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01453355-DV5277OtherRAILROAD MEDICARE
CAEFF: 2/20/2013Medicaid
CAPA19547Medicaid
CAEFF: 2/20/2013Medicaid
CABV105SMedicare PIN
CACA140890Medicare PIN
CABV105SMedicare PIN