Provider Demographics
NPI:1861722514
Name:HAINES, JENICE ANN (CPNP)
Entity type:Individual
Prefix:MRS
First Name:JENICE
Middle Name:ANN
Last Name:HAINES
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6977 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3701
Mailing Address - Country:US
Mailing Address - Phone:713-793-3754
Mailing Address - Fax:713-793-3762
Practice Address - Street 1:6977 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3701
Practice Address - Country:US
Practice Address - Phone:713-793-3754
Practice Address - Fax:713-793-3762
Is Sole Proprietor?:No
Enumeration Date:2009-12-31
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX603967363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics