Healthcare Provider Details

I. General information

NPI: 1104976950
Provider Name (Legal Business Name): MARYJANE HANEY MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7331 TAZEWELL PIKE
CORRYTON TN
37721-3516
US

IV. Provider business mailing address

7331 TAZEWELL PIKE
CORRYTON TN
37721-3516
US

V. Phone/Fax

Practice location:
  • Phone: 865-687-3622
  • Fax: 865-687-3632
Mailing address:
  • Phone: 865-687-3622
  • Fax: 865-687-3632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14603
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: