Provider Demographics
NPI:1902354707
Name:HAYNES, RAQUEL PAOLA YLMONDA (RN)
Entity Type:Individual
Prefix:MISS
First Name:RAQUEL
Middle Name:PAOLA YLMONDA
Last Name:HAYNES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 KINGS HWY
Mailing Address - Street 2:APT 5J
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-2944
Mailing Address - Country:US
Mailing Address - Phone:917-613-6737
Mailing Address - Fax:
Practice Address - Street 1:3900 KINGS HWY
Practice Address - Street 2:APT 5J
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2944
Practice Address - Country:US
Practice Address - Phone:917-613-6737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY546954-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse