Individual
MRS. AMANDA VICE HAYNIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2225 LINE AVENUE, MID CITY PEDIATRICS, SHREVEPORT, LA 71104
(318) 221-2225
(318) 459-2955
Mailing address
2225 LINE AVENUE, MID CITY PEDIATRICS, SHREVEPORT, LA 71104
(318) 221-2225
(318) 459-2955
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
29920
OK
208000000X
Pediatrics Physician
Primary
301709
LA
Other
Enumeration date
04/23/2013
Last updated
05/18/2016
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