Provider Demographics
NPI:1609463553
Name:HAINES, MINDY ANN
Entity Type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:ANN
Last Name:HAINES
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 1:11535 TWIN OAKS TRL
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-9144
Mailing Address - Country:US
Mailing Address - Phone:440-476-8541
Mailing Address - Fax:
Practice Address - Street 1:11535 TWIN OAKS TRL
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-9144
Practice Address - Country:US
Practice Address - Phone:440-476-8541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-27
Last Update Date:2020-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2802422376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker