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General NPI Number Information
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NPI Number | 1528450293
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Entity Type | Individual
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Provider Name | MARY M HAYNES APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 03/04/2015
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Last Update Date | 05/10/2021
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Provider Practice Location Address
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Address Line | 405 W GRAND AVE
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City | DAYTON
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State | OH
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Zip | 45405-7538
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Country | US
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Telephone | 937-723-3276
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Fax | 937-723-3277
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Provider Business Mailing Address
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Address Line | 1 PRESTIGE PL STE 550
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City | MIAMISBURG
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State | OH
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Zip | 45342-6115
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Country | US
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Telephone | 937-762-1310
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Fax | 937-522-8068
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN.284269
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License Number State | OH
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