Provider Demographics
NPI:1194063859
Name:HAYES, JACLYN JOAN (RN)
Entity type:Individual
Prefix:MS
First Name:JACLYN
Middle Name:JOAN
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 1:22119 480TH AVE
Mailing Address - Street 2:P.O. BOX 306
Mailing Address - City:OSAGE
Mailing Address - State:MN
Mailing Address - Zip Code:56570-9554
Mailing Address - Country:US
Mailing Address - Phone:218-573-2238
Mailing Address - Fax:218-573-3778
Practice Address - Street 1:22119 480TH AVE
Practice Address - Street 2:
Practice Address - City:OSAGE
Practice Address - State:MN
Practice Address - Zip Code:56570-9554
Practice Address - Country:US
Practice Address - Phone:218-573-2238
Practice Address - Fax:218-573-3778
Is Sole Proprietor?:No
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR189659-8163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health