Individual provider Active NPI

Paul Haynor, RN

  • Registered Nurse
  • Grand Rapids, MI
National Provider Identifier
1396436598
Registry record updated May 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
4704399723 Issued in MI
Practice address
5300 Patterson Ave SE Ste 125
Grand Rapids, MI 49512-9627
Phone
(616) 222-5601
NPI assigned
May 17, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 4704399723 MI Primary

Addresses

Primary practice location

5300 Patterson Ave SE Ste 125
Grand Rapids, MI 49512-9627

Mailing address

212 Mill St
Ionia, MI 48846-1855
Phone (616) 523-2872

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
4704399723MIMDRegistered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1684281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684281600000",
    "number": "1396436598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 MILL ST",
            "city": "IONIA",
            "state": "MI",
            "postal_code": "488461855",
            "telephone_number": "616-523-2872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5300 PATTERSON AVE SE STE 125",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495129627",
            "telephone_number": "616-222-5601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAYNOR",
        "first_name": "PAUL",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-05-17",
        "last_updated": "2023-05-17",
        "certification_date": "2023-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704399723",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.