Provider Demographics
NPI:1003954173
Name:HAYNES, RAQUEL GRACIELA (CNM)
Entity Type:Individual
Prefix:MS
First Name:RAQUEL
Middle Name:GRACIELA
Last Name:HAYNES
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 JAMES PL
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-2936
Mailing Address - Country:US
Mailing Address - Phone:516-567-2096
Mailing Address - Fax:
Practice Address - Street 1:1 BROOKDALE PLAZA BROOKDALE UNIVERSITY HOSPITAL
Practice Address - Street 2:OBGYN MIDWIFERY SERVICE RM 4C30
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212
Practice Address - Country:US
Practice Address - Phone:718-240-6278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF001200176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife