Provider Demographics
NPI:1033317904
Name:HINKLE, THERESA MARIE (NURSE-LPN)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:HINKLE
Suffix:
Gender:F
Credentials:NURSE-LPN
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:MARIE
Other - Last Name:BILLINGSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE -LPN
Mailing Address - Street 1:537 W LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-3035
Mailing Address - Country:US
Mailing Address - Phone:419-496-4188
Mailing Address - Fax:419-496-4188
Practice Address - Street 1:537 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-3035
Practice Address - Country:US
Practice Address - Phone:419-496-4188
Practice Address - Fax:419-496-4188
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN099594164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2304714Medicaid