Provider Demographics
NPI:1619121951
Name:HAYES, JUDITH MARLENE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:MARLENE
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 1:13473 SHELL BEACH RD
Mailing Address - Street 2:
Mailing Address - City:THORNVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43076-9169
Mailing Address - Country:US
Mailing Address - Phone:740-467-7202
Mailing Address - Fax:
Practice Address - Street 1:13473 SHELL BEACH RD
Practice Address - Street 2:
Practice Address - City:THORNVILLE
Practice Address - State:OH
Practice Address - Zip Code:43076-9169
Practice Address - Country:US
Practice Address - Phone:740-467-7202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.069583 MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2539542Medicaid