1851390124 NPI number — REBECCA HAYDEN GNP

Table of content: REBECCA HAYDEN GNP (NPI 1851390124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851390124 NPI number — REBECCA HAYDEN GNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAYDEN
Provider First Name:
REBECCA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
GNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851390124
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 410664
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST. LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63141-0664
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-749-7749
Provider Business Mailing Address Fax Number:
314-469-2992

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11125 DUNN ROAD SUITE 213
Provider Second Line Business Practice Location Address:
PHYSICIANS OFFICE BUILDING 2
Provider Business Practice Location Address City Name:
ST. LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63136-6132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-479-7749
Provider Business Practice Location Address Fax Number:
314-469-2992
Provider Enumeration Date:
07/19/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LG0600X , with the licence number:  RN140351 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 424877215 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00141675 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".