Provider Demographics
NPI:1457569170
Name:HAYNES, HEIDI (CRNP)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:HAYNES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 KAMBACH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15211-2112
Mailing Address - Country:US
Mailing Address - Phone:412-692-6517
Mailing Address - Fax:412-692-3412
Practice Address - Street 1:3705 5TH AVE
Practice Address - Street 2:4B220
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2584
Practice Address - Country:US
Practice Address - Phone:412-692-6517
Practice Address - Fax:412-692-3412
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009055363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics