Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | VA |
NPI | 1124358833 |
---|---|
Provider Name | Mrs. Kathryn Suzanne Haines |
First Address | Takoma Park, MD 20912-4861 |
Second Address | Takoma Park, MD 20912-4861 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/12/2009 |
Last Update Date | 18/04/2012 |