Provider Demographics
NPI:1053709998
Name:HAINES, MARY RITA (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:MARY RITA
Middle Name:
Last Name:HAINES
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 GRANGER ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02170-2521
Mailing Address - Country:US
Mailing Address - Phone:617-653-4079
Mailing Address - Fax:
Practice Address - Street 1:125 GRANGER ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02170-2521
Practice Address - Country:US
Practice Address - Phone:617-653-4079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN164853163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse