Provider Demographics
NPI:1326828906
Name:BAINES, KAWANA (RN)
Entity Type:Individual
Prefix:
First Name:KAWANA
Middle Name:
Last Name:BAINES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3952 N 143RD LN
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-8426
Mailing Address - Country:US
Mailing Address - Phone:623-281-5967
Mailing Address - Fax:
Practice Address - Street 1:325 S WILDFLOWER DR
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-6869
Practice Address - Country:US
Practice Address - Phone:623-772-5210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ282564163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool