Provider Demographics
NPI:1821748260
Name:HAINES, VANESSA
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
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 1:440 MAIN RD
Mailing Address - Street 2:
Mailing Address - City:EDDINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04428-3018
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:440 MAIN RD
Practice Address - Street 2:
Practice Address - City:EDDINGTON
Practice Address - State:ME
Practice Address - Zip Code:04428-3018
Practice Address - Country:US
Practice Address - Phone:207-843-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator