Provider Demographics
NPI:1104976950
Name:HANEY, MARYJANE (MSN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MARYJANE
Middle Name:
Last Name:HANEY
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7331 TAZEWELL PIKE
Mailing Address - Street 2:
Mailing Address - City:CORRYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37721-3516
Mailing Address - Country:US
Mailing Address - Phone:865-687-3622
Mailing Address - Fax:865-687-3632
Practice Address - Street 1:7331 TAZEWELL PIKE
Practice Address - Street 2:
Practice Address - City:CORRYTON
Practice Address - State:TN
Practice Address - Zip Code:37721-3516
Practice Address - Country:US
Practice Address - Phone:865-687-3622
Practice Address - Fax:865-687-3632
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14603363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHHANP24581Medicare PIN