Provider Demographics
NPI:1265524755
Name:HAYNES, GWENDOLYN ELIZABETH (CNM)
Entity type:Individual
Prefix:MRS
First Name:GWENDOLYN
Middle Name:ELIZABETH
Last Name:HAYNES
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 30TH STREET ,SUITE 2
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609
Mailing Address - Country:US
Mailing Address - Phone:510-775-2229
Mailing Address - Fax:510-590-9938
Practice Address - Street 1:419 30TH STREET ,SUITE 2
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609
Practice Address - Country:US
Practice Address - Phone:510-775-2229
Practice Address - Fax:510-590-9938
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1736176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA579100OtherNURSE PRACTITIONER