Provider Demographics
NPI:1851598734
Name:HAYNES, VERMONICA SHAVETTE (RN)
Entity Type:Individual
Prefix:MRS
First Name:VERMONICA
Middle Name:SHAVETTE
Last Name:HAYNES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1231 MILLS POINTE DR
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-6227
Mailing Address - Country:US
Mailing Address - Phone:225-654-6053
Mailing Address - Fax:225-273-6224
Practice Address - Street 1:11628 S CHOCTAW DR
Practice Address - Street 2:SUITE 207
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-2107
Practice Address - Country:US
Practice Address - Phone:225-273-6224
Practice Address - Fax:225-273-6225
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN107608163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse