Healthcare Provider Details

I. General information

NPI: 1093776361
Provider Name (Legal Business Name): LINDA HAINES SELF FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 HARTFORD ST
HOULTON ME
04730-1844
US

IV. Provider business mailing address

1543 COUNTY ROAD 3350
CLARKSVILLE AR
72830-8162
US

V. Phone/Fax

Practice location:
  • Phone: 207-532-3289
  • Fax: 207-532-6071
Mailing address:
  • Phone: 479-754-0851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP111009
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: