Provider Demographics
NPI:1720206410
Name:HAYNES, CHRISTINE BOTELER (RN)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:BOTELER
Last Name:HAYNES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4913 DOWNLAND TER
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-3109
Mailing Address - Country:US
Mailing Address - Phone:301-774-3330
Mailing Address - Fax:
Practice Address - Street 1:7055 SAMUEL MORSE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-3439
Practice Address - Country:US
Practice Address - Phone:443-718-8036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR045978163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse