Provider Demographics
NPI:1700127511
Name:HAYNES, SHAKESHIA REENA (LPN)
Entity type:Individual
Prefix:
First Name:SHAKESHIA
Middle Name:REENA
Last Name:HAYNES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1474 WHITE AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44307-1045
Mailing Address - Country:US
Mailing Address - Phone:330-252-1180
Mailing Address - Fax:
Practice Address - Street 1:1474 WHITE AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-1045
Practice Address - Country:US
Practice Address - Phone:330-252-1180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH150211164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse