Individual
CARISSA HAINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
122 WYOMING ST, DAYTON, OH 45409-2731
(937) 223-4461
(937) 449-7603
Mailing address
3170 KETTERING BLVD BLDG B, MORAINE, OH 45439-1924
(937) 991-3188
(937) 223-9811
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APRN.CNP13356
OH
363LF0000X
Family Nurse Practitioner
COA.13356-NP
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0294150
—
OH
Enumeration date
09/25/2012
Last updated
03/23/2022
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