Provider Demographics
NPI:1154370377
Name:HAYNOS, MARY F (CRNP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:F
Last Name:HAYNOS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
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Mailing Address - Street 1:12001 FERRARA AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-4706
Mailing Address - Country:US
Mailing Address - Phone:301-279-2779
Mailing Address - Fax:240-403-0190
Practice Address - Street 1:19701 EXECUTIVE PARK CIR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-2639
Practice Address - Country:US
Practice Address - Phone:301-946-6623
Practice Address - Fax:301-946-1107
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR113971363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408582500Medicaid
Q52071Medicare UPIN
DC017894M50Medicare ID - Type Unspecified