Provider Demographics
NPI:1679785836
Name:HAYNIE, AMANDA BROOK (N A 2)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:BROOK
Last Name:HAYNIE
Suffix:
Gender:F
Credentials:N A 2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 JOE HALE DR
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-3868
Mailing Address - Country:US
Mailing Address - Phone:423-791-0597
Mailing Address - Fax:
Practice Address - Street 1:810 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-3285
Practice Address - Country:US
Practice Address - Phone:423-798-1749
Practice Address - Fax:423-798-1755
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide