Provider Demographics
NPI:1093421455
Name:HINES, JESSICA RULEAH
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RULEAH
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 1:39 POLLUX CIR E
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-2027
Mailing Address - Country:US
Mailing Address - Phone:757-774-1171
Mailing Address - Fax:
Practice Address - Street 1:39 POLLUX CIR E
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701-2027
Practice Address - Country:US
Practice Address - Phone:757-774-1171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-23391374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide