Provider Demographics
NPI:1811141138
Name:HAYNES, PATRICIA
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:HAYNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 OCEAN AVE
Mailing Address - Street 2:APT 1B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-3271
Mailing Address - Country:US
Mailing Address - Phone:347-750-8153
Mailing Address - Fax:
Practice Address - Street 1:1306 OCEAN AVE
Practice Address - Street 2:APT 1B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-3271
Practice Address - Country:US
Practice Address - Phone:347-750-8153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235894164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse