Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | NP19761 | OH |
NPI | 1023207537 |
---|---|
Provider Name | Miss Meredith Janell Haynes |
First Address | Lima, OH 45801-4332 |
Second Address | Lima, OH 45801-2823 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2007 |
Last Update Date | 18/11/2016 |