Basic Information
| Provider Information | |||||||||
| NPI: | 1093045148 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAIRE | ||||||||
| FirstName: | ANNA | ||||||||
| MiddleName: | CORI | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1236 HIGHWAY 5 | ||||||||
| Address2: | |||||||||
| City: | ROMANCE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012301519 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3302 EAST MOORE ST. | ||||||||
| Address2: | |||||||||
| City: | SEARCY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012684181 | ||||||||
| FaxNumber: | 5012685301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2010 | ||||||||
| LastUpdateDate: | 01/12/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | L49230 | AR | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.