Provider Demographics
NPI:1467480699
Name:HAYNES, JANICE KLAIBER (NP)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:KLAIBER
Last Name:HAYNES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 CANDACE DR
Mailing Address - Street 2:
Mailing Address - City:RIDGEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29472-8802
Mailing Address - Country:US
Mailing Address - Phone:843-871-5847
Mailing Address - Fax:843-767-2102
Practice Address - Street 1:5319 PARKSHIRE WAY
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-2051
Practice Address - Country:US
Practice Address - Phone:843-767-2121
Practice Address - Fax:843-767-2102
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCOB518363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCB924294756Medicare UPIN