Provider Demographics
NPI:1881800530
Name:HAYEN, CARRIE MARIE (DO)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:MARIE
Last Name:HAYEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 S LINCOLN RD
Mailing Address - Street 2:STE 100
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-1293
Mailing Address - Country:US
Mailing Address - Phone:906-225-3630
Mailing Address - Fax:906-225-4537
Practice Address - Street 1:710 S LINCOLN RD
Practice Address - Street 2:STE 100
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-1292
Practice Address - Country:US
Practice Address - Phone:906-786-4628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016767207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1881800530Medicaid
MIG46040137Medicare PIN
MI1881800530Medicaid