Healthcare Provider Details

I. General information

NPI: 1346974417
Provider Name (Legal Business Name): CARMELLA D HAINES FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N BEAUREGARD ST STE 110
ALEXANDRIA VA
22311-1715
US

IV. Provider business mailing address

1500 N BEAUREGARD ST STE 110
ALEXANDRIA VA
22311-1715
US

V. Phone/Fax

Practice location:
  • Phone: 703-370-9002
  • Fax:
Mailing address:
  • Phone: 703-370-9002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberNUR-RN-LIC-127601
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: