MEDICARE: MRS. MARY F HAYNOS CRNP

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	363LA2200X	Adult Health Nurse Practitioner	R113971	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154370377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY F HAYNOS CRNP

Provider Business Mailing Address
First Line	:	12001 FERRARA AVE
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20906-4706
Country	:	US
Telephone Number	:	301-279-2779
Fax Number	:	240-403-0190

Provider Business Practice Location Address
First Line	:	19701 EXECUTIVE PARK CIR
Second Line	:
City	:	GERMANTOWN
State	:	MD
Zip	:	20874-2639
Country	:	US
Telephone Number	:	301-946-6623
Fax Number	:	301-946-1107

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

Provider Enumeration Date	:	05/06/2006
Last Update Date	:	02/05/2018

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