Provider Demographics
NPI:1427406438
Name:HAYNES, NATALIE JUDITH
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:JUDITH
Last Name:HAYNES
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 1:813 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-2103
Mailing Address - Country:US
Mailing Address - Phone:810-334-8007
Mailing Address - Fax:
Practice Address - Street 1:813 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-2103
Practice Address - Country:US
Practice Address - Phone:810-334-8007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other