Provider Demographics
NPI:1538427216
Name:HAYNES, SONIA POLK (LPN)
Entity type:Individual
Prefix:MRS
First Name:SONIA
Middle Name:POLK
Last Name:HAYNES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-7936
Mailing Address - Country:US
Mailing Address - Phone:228-261-4601
Mailing Address - Fax:228-206-2266
Practice Address - Street 1:2801 MONROE ST
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-7936
Practice Address - Country:US
Practice Address - Phone:228-261-4601
Practice Address - Fax:228-206-2266
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP203068164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse