=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952315897
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALICE K. HAYNES ANP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2006
-----------------------------------------------------
Last Update Date | 05/21/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 368 FAUNCE CORNER ROAD
-----------------------------------------------------
City | NORTH DARTMOUTH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02747-1271
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-985-5014
-----------------------------------------------------
Fax | 508-985-5045
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 MILL RD SUITE 180
-----------------------------------------------------
City | FAIRHAVEN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02719-5252
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-973-2000
-----------------------------------------------------
Fax | 508-973-2001
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | APRN00590
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------