Provider Demographics
NPI:1851390124
Name:HAYDEN, REBECCA (GNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:HAYDEN
Suffix:
Gender:F
Credentials:GNP
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 410664
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-0664
Mailing Address - Country:US
Mailing Address - Phone:314-749-7749
Mailing Address - Fax:314-469-2992
Practice Address - Street 1:11125 DUNN ROAD SUITE 213
Practice Address - Street 2:PHYSICIANS OFFICE BUILDING 2
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6132
Practice Address - Country:US
Practice Address - Phone:314-479-7749
Practice Address - Fax:314-469-2992
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORN140351363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO424877215Medicaid
MOP00141675OtherRAILROAD MEDICARE
MOS85513Medicare UPIN
MO424877215Medicaid