Provider Demographics
NPI:1568661262
Name:HAYES, JOHN ROBERT (RN)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
Last Name:HAYES
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4831 KORTE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-4106
Mailing Address - Country:US
Mailing Address - Phone:313-581-7747
Mailing Address - Fax:
Practice Address - Street 1:4831 KORTE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-4106
Practice Address - Country:US
Practice Address - Phone:313-581-7747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704213837163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH200429745415OtherDRIVERS LICENSE