Provider Demographics
NPI:1164757845
Name:HAYWOOD, CHRISTINA MARIE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:MARIE
Last Name:HAYWOOD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 FITCH ST
Mailing Address - Street 2:
Mailing Address - City:WALTON
Mailing Address - State:NY
Mailing Address - Zip Code:13856-1211
Mailing Address - Country:US
Mailing Address - Phone:607-348-8487
Mailing Address - Fax:
Practice Address - Street 1:23 FITCH ST
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:NY
Practice Address - Zip Code:13856-1211
Practice Address - Country:US
Practice Address - Phone:607-348-8487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY281084164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse