Provider Demographics
NPI:1679979520
Name:HAYES, LEZA (PA-C)
Entity Type:Individual
Prefix:
First Name:LEZA
Middle Name:
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:PO BOX 1161
Mailing Address - Street 2:
Mailing Address - City:BORING
Mailing Address - State:OR
Mailing Address - Zip Code:97009-1161
Mailing Address - Country:US
Mailing Address - Phone:503-312-0994
Mailing Address - Fax:
Practice Address - Street 1:8614 E MILL PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-2059
Practice Address - Country:US
Practice Address - Phone:360-896-8963
Practice Address - Fax:360-896-9002
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2022-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR169441363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant