MEDICARE: MRS. MARYJANE HANEY MSN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	14603	TN

General Provider Information

NPI Number	:	1104976950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARYJANE HANEY MSN, FNP-C

Provider Business Mailing Address
First Line	:	7331 TAZEWELL PIKE
Second Line	:
City	:	CORRYTON
State	:	TN
Zip	:	37721-3516
Country	:	US
Telephone Number	:	865-687-3622
Fax Number	:	865-687-3632

Provider Business Practice Location Address
First Line	:	7331 TAZEWELL PIKE
Second Line	:
City	:	CORRYTON
State	:	TN
Zip	:	37721-3516
Country	:	US
Telephone Number	:	865-687-3622
Fax Number	:	865-687-3632

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	09/17/2012

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