Healthcare Provider Details

I. General information

NPI: 1619189982
Provider Name (Legal Business Name): MARY F. HAIRE R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 CHEROKEE TRL POLK COUNTY HEALTH DEPARTMENT
COPPERHILL TN
37317-5200
US

IV. Provider business mailing address

840 CHEROKEE TRL POLK COUNTY HEALTH DEPARTMENT
COPPERHILL TN
37317-5200
US

V. Phone/Fax

Practice location:
  • Phone: 423-496-3275
  • Fax: 423-496-4442
Mailing address:
  • Phone: 423-496-3275
  • Fax: 423-496-4442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number31537
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: