Provider Demographics
NPI:1275523193
Name:HAYNES, CHRISTOPHER P (DNP)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:P
Last Name:HAYNES
Suffix:
Gender:M
Credentials:DNP
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Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MAIL STOP 21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:651-254-2300
Mailing Address - Fax:651-254-2301
Practice Address - Street 1:640 JACKSON ST
Practice Address - Street 2:MAIL STOP 11302C
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-4786
Practice Address - Fax:651-254-9426
Is Sole Proprietor?:No
Enumeration Date:2005-10-22
Last Update Date:2015-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC900422363LA2200X
MNR165377-3363LA2200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN906415000Medicaid
MNHP 48953OtherHEALTHPARTNERS
NCP00184086OtherRAILROAD MEDICARE
007796OtherMEDIPAC
007796OtherMEDIPAC
MN906415000Medicaid