Provider Demographics
NPI:1669076154
Name:HAYDEN, SARAH ANNE
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:ANNE
Last Name:HAYDEN
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 1:108 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-2812
Mailing Address - Country:US
Mailing Address - Phone:740-507-4203
Mailing Address - Fax:
Practice Address - Street 1:108 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-2812
Practice Address - Country:US
Practice Address - Phone:740-507-4203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH42044623747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4204462OtherOHIO DODD
OH0192062Medicaid