Provider Demographics
NPI:1750452082
Name:HAINES, MONICA M (DO)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:M
Last Name:HAINES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24125 SE 261ST PLACE
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038
Mailing Address - Country:US
Mailing Address - Phone:425-413-8642
Mailing Address - Fax:
Practice Address - Street 1:24031 104TH AVE SE
Practice Address - Street 2:US HEALTHWORKS
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031
Practice Address - Country:US
Practice Address - Phone:253-852-1824
Practice Address - Fax:253-859-5139
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001014207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E17785Medicare UPIN