Provider Demographics
NPI:1033834478
Name:HINES, MILDRED 71027
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:71027
Last Name:HINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 OUTLAW RIDING CLUB RD
Mailing Address - Street 2:
Mailing Address - City:FRIERSON
Mailing Address - State:LA
Mailing Address - Zip Code:71027
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:219 OUTLAW RIDING CLUB RD
Practice Address - Street 2:
Practice Address - City:FRIERSON
Practice Address - State:LA
Practice Address - Zip Code:71027
Practice Address - Country:US
Practice Address - Phone:318-564-5833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide