Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 1-149853 | AL |
NPI | 1508321191 |
---|---|
Provider Name | Andrew Haynes |
First Address | Oxford, AL 36203-9251 |
Second Address | Anniston, AL 36207-4716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2019 |
Last Update Date | 07/02/2019 |