Healthcare Provider Details

I. General information

NPI: 1255102661
Provider Name (Legal Business Name): DEANNA MARIE HAYNES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 01/15/2024
Certification Date: 01/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 S LANCASTER RD
DALLAS TX
75216-7167
US

IV. Provider business mailing address

5419 ENCHANTED LN
DALLAS TX
75227-1424
US

V. Phone/Fax

Practice location:
  • Phone: 469-626-2136
  • Fax:
Mailing address:
  • Phone: 469-626-2136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number1040123
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: