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Individual

SHANNON NICOLE HAINES

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
303 W LINCOLN AVE, #105, ANAHEIM, CA 92805-2936
(917) 285-0361
Mailing address
475 DOVER CIR, BREA, CA 92821-6024
(917) 285-0361

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
20777
CA
363LA2200X
Adult Health Nurse Practitioner
258409
MA
363LA2200X
Adult Health Nurse Practitioner
304491
NY

Other

Enumeration date
02/08/2006
Last updated
01/10/2012
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