Individual
COLLEEN HAYNIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
500 E 19TH ST, MOUNTAIN GROVE, MO 65711-1114
(417) 926-6563
(417) 926-5820
Mailing address
PO BOX 1100, WEST PLAINS, MO 65775-1100
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
087357
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
427890629
—
MO
Enumeration date
01/15/2007
Last updated
05/24/2017
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