MEDICARE: MARY HAYNES F.N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	NP12899	CA

General Provider Information

NPI Number	:	1902896921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY HAYNES F.N.P.

Provider Business Mailing Address
First Line	:	45104 10TH ST W
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93534-2310
Country	:	US
Telephone Number	:	661-942-2391
Fax Number	:

Provider Business Practice Location Address
First Line	:	45104 10TH ST W
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93534-2310
Country	:	US
Telephone Number	:	661-942-2391
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	12/01/2021

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