Basic Information
| Provider Information | |||||||||
| NPI: | 1326686908 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAINES | ||||||||
| FirstName: | DANA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10900 W 44TH AVE UNIT 200 | ||||||||
| Address2: | |||||||||
| City: | WHEAT RIDGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800332742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039931330 | ||||||||
| FaxNumber: | 3039575757 | ||||||||
| Practice Location | |||||||||
| Address1: | 10900 W 44TH AVE UNIT 200 | ||||||||
| Address2: | |||||||||
| City: | WHEAT RIDGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800332742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039931330 | ||||||||
| FaxNumber: | 3039575757 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2019 | ||||||||
| LastUpdateDate: | 12/14/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/14/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | APN-0995223-NP | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No ID Information.