Provider Demographics
NPI:1124358833
Name:HAINES, KATHRYN SUZANNE (CPM)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:SUZANNE
Last Name:HAINES
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6802 PRINCE GEORGES AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-4861
Mailing Address - Country:US
Mailing Address - Phone:202-257-8007
Mailing Address - Fax:
Practice Address - Street 1:6802 PRINCE GEORGES AVE
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-4861
Practice Address - Country:US
Practice Address - Phone:202-257-8007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-31
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
VA176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No176B00000XOther Service ProvidersMidwife