Provider Demographics
NPI:1477952299
Name:HAINES, DENISE (RN, RD/LD, CDE)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:HAINES
Suffix:
Gender:F
Credentials:RN, RD/LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 CEDAR ST SE
Mailing Address - Street 2:SUITE 4660
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4917
Mailing Address - Country:US
Mailing Address - Phone:505-563-6530
Mailing Address - Fax:505-563-6325
Practice Address - Street 1:201 CEDAR ST SE
Practice Address - Street 2:SUITE 4660
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4917
Practice Address - Country:US
Practice Address - Phone:505-563-6530
Practice Address - Fax:505-563-6325
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLD-0947133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered