Provider Demographics
NPI:1619925542
Name:HAYES, JENNIFER M (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:HAYES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 W RIVER WOODS PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1088
Mailing Address - Country:US
Mailing Address - Phone:414-323-6880
Mailing Address - Fax:
Practice Address - Street 1:377 W RIVER WOODS PKWY STE 201
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53212-1088
Practice Address - Country:US
Practice Address - Phone:414-323-6880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI918-023363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42969700Medicaid
WI9114OtherDEAN HEALTH INSURANCE
WI010654375Medicare PIN
WI970017549Medicare PIN
WI42969700Medicaid
WI024454340Medicare PIN
WI065574150Medicare PIN