Healthcare Provider Details

I. General information

NPI: 1912352154
Provider Name (Legal Business Name): LORRAINE HAINES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 VISTA BLVD
SPARKS NV
89434-6501
US

IV. Provider business mailing address

780 KUENZLI ST STE 202
RENO NV
89502-0845
US

V. Phone/Fax

Practice location:
  • Phone: 775-982-5000
  • Fax: 775-982-3900
Mailing address:
  • Phone: 775-982-5262
  • Fax: 775-982-5496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number16773
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN002278
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: