Provider Demographics
NPI:1891009338
Name:HAYES, MARCIA ANN
Entity Type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:ANN
Last Name:HAYES
Suffix:
Gender:F
Credentials:
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 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7222
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:575 4TH ST
Practice Address - Street 2:
Practice Address - City:KEWAUNEE
Practice Address - State:WI
Practice Address - Zip Code:54216-1785
Practice Address - Country:US
Practice Address - Phone:920-388-4640
Practice Address - Fax:920-388-0479
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4236363LF0000X
WI6017-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK400243111Medicare Oscar/Certification
WIK400164397Medicare Oscar/Certification
WIK400226031Medicare Oscar/Certification