| Doctor Name: | BETH ANN HAYDEN |
| NPI Number: | 1003172719 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 28172850A |
| Business Practice Address: | 1509 State St La Porte, IN - 463503115 |
| Business Phone Number: | 2193243431 |
| Business Fax Number: | 2193623802 |
| Mailing Address: | Po Box 1690, LA PORTE |
| State: | IN |
| Postal Code: | 463521690 |
| Phone Number: | 2193262312 |
| Fax Number: | 2193262584 |
| NPI Enumeration Date: | 04/06/2012 |
| NPI Last Update Date: | 04/06/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 28172850A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |