Doctor Name: | JENNIFER NICOLE HAYNES |
NPI Number: | 1174869200 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-C |
License Number: | 5005798 |
Business Practice Address: | 2311 Lewisville Clemmons Rd Clemmons, NC - 270128905 |
Business Phone Number: | 3367130420 |
Business Fax Number: | |
Mailing Address: | 374 Tortoise Ln, WINSTON SALEM |
State: | NC |
Postal Code: | 271277004 |
Phone Number: | 3368298215 |
Fax Number: | |
NPI Enumeration Date: | 12/18/2012 |
NPI Last Update Date: | 12/18/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 5005798 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |