Healthcare Provider Details

I. General information

NPI: 1285604314
Provider Name (Legal Business Name): MICHELE J HAINES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 N DETROIT ST
WEST LIBERTY OH
43357-0817
US

IV. Provider business mailing address

PO BOX 817
WEST LIBERTY OH
43357-0817
US

V. Phone/Fax

Practice location:
  • Phone: 937-465-8065
  • Fax: 937-465-3505
Mailing address:
  • Phone: 937-465-8065
  • Fax: 937-465-3505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN234156
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: