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NPI Code Detail

MEDICARE: ERICCA HAYNES

MEDICARE: ERICCA HAYNES
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
1163W00000XRegistered NurseRN577355PA

General Provider Information

NPI Number : 1447654157
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERICCA HAYNES
Provider Business Mailing Address
First Line : 18279 CONNEAUT LAKE RD
Second Line :
City : MEADVILLE
State : PA
Zip : 16335-3759
Country : US
Telephone Number : 814-337-8383
Fax Number : 814-337-8380
Provider Business Practice Location Address
First Line : 18279 CONNEAUT LAKE RD
Second Line :
City : MEADVILLE
State : PA
Zip : 16335-3759
Country : US
Telephone Number : 814-337-8383
Fax Number : 814-337-8380
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/09/2014
Last Update Date : 10/09/2014

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Directions to “ ERICCA HAYNES ” Practice Location

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