Provider Demographics
NPI:1578867610
Name:HAYNES, CRYSTAL MICHELLE
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:MICHELLE
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 1:7255 W SUNSET RD APT 1070
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-1906
Mailing Address - Country:US
Mailing Address - Phone:702-569-3589
Mailing Address - Fax:928-569-3581
Practice Address - Street 1:7255 W SUNSET RD APT 1070
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-1906
Practice Address - Country:US
Practice Address - Phone:702-569-3589
Practice Address - Fax:928-569-3581
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner