Provider Demographics
NPI:1992762462
Name:HAYNEY, BEVERLY B (CRNP)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:B
Last Name:HAYNEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1677
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4400 CARLISLE PIKE
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4132
Practice Address - Country:US
Practice Address - Phone:717-975-9800
Practice Address - Fax:717-975-5509
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP 001018B163WG0000X
PASP001018B363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001401716OtherHIGHMARK BLUE SHIELD
PAP00405871OtherRAILROAD MEDICARE
PA50037295OtherBLUE CROSS
PA7259379OtherCIGNA
PA1559514OtherGATEWAY
PASP001018BOtherMEDICARE NUMBER
PA1559514OtherGATEWAY