Individual
MR. ROY G. HAYNES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2200 JACOBSSEN DR STE B, NORMAL, IL 61761-5516
(309) 451-1123
(309) 451-1212
Mailing address
2200 JACOBSSEN DR STE B, NORMAL, IL 61761-5516
(309) 451-1123
(309) 451-1212
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041-217502
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
209-001422
IL
367500000X
Certified Registered Nurse Anesthetist
28163503A
IN
Other
Enumeration date
08/16/2006
Last updated
12/08/2023
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