Provider Demographics
NPI:1922137587
Name:HAYWARD, SANDRA JEAN (RN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JEAN
Last Name:HAYWARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:JEAN
Other - Last Name:HAYWARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:12 WARNER LN
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03842-1037
Mailing Address - Country:US
Mailing Address - Phone:603-601-2397
Mailing Address - Fax:603-601-2397
Practice Address - Street 1:12 WARNER LN
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03842-1037
Practice Address - Country:US
Practice Address - Phone:603-601-2397
Practice Address - Fax:603-601-2397
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA159318163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0340511Medicaid