Provider Demographics
NPI:1235483686
Name:HAINES, NATASHA
Entity Type:Individual
Prefix:MS
First Name:NATASHA
Middle Name:
Last Name:HAINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 BLASCHKO AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:WI
Mailing Address - Zip Code:54612-1835
Mailing Address - Country:US
Mailing Address - Phone:608-323-8134
Mailing Address - Fax:608-323-8434
Practice Address - Street 1:1625 E BLASCHKO AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:WI
Practice Address - Zip Code:54612-1835
Practice Address - Country:US
Practice Address - Phone:608-323-8134
Practice Address - Fax:608-323-8434
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician