Healthcare Provider Details

I. General information

NPI: 1023207537
Provider Name (Legal Business Name): MEREDITH JANELL HAYNES PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2007
Last Update Date: 11/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 N MAIN ST
LIMA OH
45801-2823
US

IV. Provider business mailing address

329 N WEST ST
LIMA OH
45801-4332
US

V. Phone/Fax

Practice location:
  • Phone: 419-516-0327
  • Fax: 419-225-8878
Mailing address:
  • Phone: 419-221-3072
  • Fax: 419-549-5671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberNP19761
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number322319
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: