Provider Demographics
NPI:1790438414
Name:HAYNES, INDIA LEEANN
Entity Type:Individual
Prefix:
First Name:INDIA
Middle Name:LEEANN
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 1:100 SAINT NICHOLAS AVE APT 3D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-2888
Mailing Address - Country:US
Mailing Address - Phone:347-631-6564
Mailing Address - Fax:
Practice Address - Street 1:100 SAINT NICHOLAS AVE APT 3D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-2888
Practice Address - Country:US
Practice Address - Phone:347-631-6564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY833290163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse