Provider Demographics
NPI:1598936981
Name:HAINES, DIANE E (ARNP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:E
Last Name:HAINES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-3562
Mailing Address - Country:US
Mailing Address - Phone:620-793-7520
Mailing Address - Fax:620-791-6893
Practice Address - Street 1:514 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-3562
Practice Address - Country:US
Practice Address - Phone:620-793-7520
Practice Address - Fax:620-791-6893
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS46147363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care