MEDICARE: MRS. VERMONICA SHAVETTE HAYNES RN

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	163W00000X	Registered Nurse	RN107608	LA

General Provider Information

NPI Number	:	1851598734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VERMONICA SHAVETTE HAYNES RN

Provider Business Mailing Address
First Line	:	1231 MILLS POINTE DR
Second Line	:
City	:	ZACHARY
State	:	LA
Zip	:	70791-6227
Country	:	US
Telephone Number	:	225-654-6053
Fax Number	:	225-273-6224

Provider Business Practice Location Address
First Line	:	11628 S CHOCTAW DR
Second Line	:	SUITE 207
City	:	BATON ROUGE
State	:	LA
Zip	:	70815-2107
Country	:	US
Telephone Number	:	225-273-6224
Fax Number	:	225-273-6225

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

Provider Enumeration Date	:	07/02/2007
Last Update Date	:	07/08/2007

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