Provider Demographics
NPI:1669412474
Name:HAYES, ANGELA W (CRNA)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:W
Last Name:HAYES
Suffix:
Gender:F
Credentials:CRNA
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 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-364-3300
Mailing Address - Fax:701-364-8906
Practice Address - Street 1:3000 32ND AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6132
Practice Address - Country:US
Practice Address - Phone:701-364-8000
Practice Address - Fax:701-364-8078
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1764367500000X
NDR25907367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDDA9011025862OtherPREF 1 #
ND2001333OtherMEDICA INNOVIS #
ND21758OtherNDBS #
ND096673800Medicaid
ND151317OtherUCARE
ND2001334OtherMEDICA FARGO #
ND1195469OtherARAZ #
ND56G44HAOtherMNBS #
ND12643Medicaid
NDHP31698OtherHEALTHPARTNERS #
ND096673800Medicaid
ND1195469OtherARAZ #
NDDA9011025862OtherPREF 1 #
ND713174Medicare PIN