Individual
MIRIAM L. HAYNES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
200 RETREAT AVENUE, HARTFORD HOSPITAL PSYCHIATRY DEPT, HARTFORD, CT 06106-3310
(860) 545-7330
Mailing address
PO BOX 415933, HARTFORD HOSPITAL PROFESSIONAL SERVICES, BOSTON, MA 02241-5933
(860) 545-7602
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
004945
CT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
004965
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004049458
—
CT
Enumeration date
04/25/2012
Last updated
09/05/2013
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