Provider Demographics
NPI:1982066742
Name:HAYES, JUSTINE (RN)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:HAYES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 GRANVILLE ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-5218
Mailing Address - Country:US
Mailing Address - Phone:617-435-0216
Mailing Address - Fax:
Practice Address - Street 1:7 GRANVILLE ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-5218
Practice Address - Country:US
Practice Address - Phone:617-435-0216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2283706163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse