Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 71012059A | IN |
NPI | 1528728755 |
---|---|
Provider Name | Haylee Dianna Vines-Justice |
First Address | Terre Haute, IN 47805-7948 |
Second Address | Terre Haute, IN 47804-2780 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2021 |
Last Update Date | 29/12/2021 |