Provider Demographics
NPI:1649206632
Name:HAYS, HEIDI LISA (CRNA)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:LISA
Last Name:HAYS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:HEIDI
Other - Middle Name:HAYS
Other - Last Name:LUTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:10628 PARK RD
Mailing Address - Street 2:ANESTHESIA DEPARTMENT
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-8407
Mailing Address - Country:US
Mailing Address - Phone:704-667-1977
Mailing Address - Fax:
Practice Address - Street 1:10628 PARK RD
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8407
Practice Address - Country:US
Practice Address - Phone:704-667-1977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC155307367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNAN636Medicaid
NC8051812Medicaid
NC8051812Medicaid