Provider Demographics
NPI:1457066458
Name:HAINES, MARICRUZ (APRN)
Entity type:Individual
Prefix:
First Name:MARICRUZ
Middle Name:
Last Name:HAINES
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:MARICRUZ
Other - Middle Name:
Other - Last Name:HEADRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1700 SW COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66621-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:123 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:GUYMON
Practice Address - State:OK
Practice Address - Zip Code:73942-3606
Practice Address - Country:US
Practice Address - Phone:580-338-3361
Practice Address - Fax:580-338-1021
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OK221870363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program