Individual
MRS. DIALENE R HAINES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
STNA
Contact information
Practice address
4200 WESTBROOK DR APT 110, BROOKLYN, OH 44144-1201
(216) 777-9316
Mailing address
4200 WESTBROOK DR APT 110, BROOKLYN, OH 44144-1201
(216) 777-9316
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
402051890318
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
402051890318
STNA
OH
Enumeration date
04/23/2019
Last updated
06/11/2019
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