Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 4704190776 | MI |
NPI | 1013222736 |
---|---|
Provider Name | Gregory John Hayter |
First Address | Lansing, MI 48910-1122 |
Second Address | Lansing, MI 48912-1806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2010 |
Last Update Date | 19/09/2019 |