William Otis Haines

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

45023378A Issued in IN

Practice address

770 E Dupont Rd
Fort Wayne, IN 46825-2056

Phone

(260) 451-8242

NPI assigned

Oct 27, 2022

Last updated

Oct 27, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1666828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666828800000",
    "number": "1619694882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9433 BOBCAT TRL",
            "city": "LEO",
            "state": "IN",
            "postal_code": "467659360",
            "telephone_number": "260-437-4643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "770 E DUPONT RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468252056",
            "telephone_number": "260-451-8242"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "720 Northwestern Ave",
            "address_purpose": "LOCATION",
            "city": "West Lafayette",
            "state": "IN",
            "postal_code": "479062652",
            "country_code": "US",
            "telephone_number": "765-743-1554",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAINES",
        "first_name": "WILLIAM",
        "middle_name": "OTIS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-10-27",
        "last_updated": "2022-10-27",
        "certification_date": "2022-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IN",
            "license": "45023378A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Alexandra Hagen
• Jennifer Hager, DNP, MBA, CRNA
• Breanna Haglund, PA
• Eunice Wanjiku Hahn, PMHNP
• Ruby Hahn
• Mallory Hainlin
• Danelle Hair
• Mallory B Haji, CRNP
• Shamir Haji, M.D.
• Linda Hake

• Student in an Organized Health Care Education/Training Program in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Student in an Organized Health Care Education/Training Program in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2022; 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.