Provider Demographics
NPI:1760594881
Name:HAYES, DIANA (CFNP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:HAYES
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 W KING ST
Mailing Address - Street 2:PO BOX 456
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-2120
Mailing Address - Country:US
Mailing Address - Phone:989-725-6528
Mailing Address - Fax:989-723-9446
Practice Address - Street 1:239 N STATE RD
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-9075
Practice Address - Country:US
Practice Address - Phone:989-743-3415
Practice Address - Fax:989-743-6180
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704143423363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1760594881Medicaid
MIN90910002Medicare PIN
MIP07412Medicare UPIN