Provider Demographics
NPI:1497386098
Name:HAYCOOK, MARIE E
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:E
Last Name:HAYCOOK
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 1:130 AURORA DR
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:KS
Mailing Address - Zip Code:67665-2807
Mailing Address - Country:US
Mailing Address - Phone:785-280-3691
Mailing Address - Fax:
Practice Address - Street 1:200 S MAIN ST BLDG B
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:KS
Practice Address - Zip Code:67665-2920
Practice Address - Country:US
Practice Address - Phone:785-483-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-01
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5380297081363LF0000X
KS53-80297-081363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily