Healthcare Provider Details

I. General information

NPI: 1528450293
Provider Name (Legal Business Name): MARY M HAYNES APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY BAIR

II. Dates (important events)

Enumeration Date: 03/04/2015
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W GRAND AVE
DAYTON OH
45405-7538
US

IV. Provider business mailing address

1 PRESTIGE PL STE 550
MIAMISBURG OH
45342-6115
US

V. Phone/Fax

Practice location:
  • Phone: 937-723-3276
  • Fax: 937-723-3277
Mailing address:
  • Phone: 937-762-1310
  • Fax: 937-522-8068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN.284269
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: