Healthcare Provider Details

I. General information

NPI: 1912189614
Provider Name (Legal Business Name): VALERIE VERENA HAYNES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 VETERANS DRIVE
TACOMA WA
98493-0001
US

IV. Provider business mailing address

10502 90TH AVE SW
LAKEWOOD WA
98498-3721
US

V. Phone/Fax

Practice location:
  • Phone: 253-583-1727
  • Fax:
Mailing address:
  • Phone: 253-581-8585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00114565
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: