Provider Demographics
NPI:1285820928
Name:HAYES, TRINDA LEE (LPN)
Entity type:Individual
Prefix:MRS
First Name:TRINDA
Middle Name:LEE
Last Name:HAYES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:TRINDA
Other - Middle Name:LEE
Other - Last Name:JANTZI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9574 N STEUBEN RD
Mailing Address - Street 2:APT 2
Mailing Address - City:REMSEN
Mailing Address - State:NY
Mailing Address - Zip Code:13438-4651
Mailing Address - Country:US
Mailing Address - Phone:315-865-5621
Mailing Address - Fax:
Practice Address - Street 1:31 REDMOND ROAD
Practice Address - Street 2:
Practice Address - City:BARNEVELD
Practice Address - State:NY
Practice Address - Zip Code:13304
Practice Address - Country:US
Practice Address - Phone:315-896-4225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-17
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2085331164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02666833Medicaid