Provider Demographics
NPI:1093475493
Name:HINES, MARLENA V
Entity Type:Individual
Prefix:
First Name:MARLENA
Middle Name:V
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 1:348 RED BLANKET RD
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:OR
Mailing Address - Zip Code:97536-9720
Mailing Address - Country:US
Mailing Address - Phone:458-225-0214
Mailing Address - Fax:
Practice Address - Street 1:1301 W STEWART AVE
Practice Address - Street 2:#1
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501
Practice Address - Country:US
Practice Address - Phone:541-261-8061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide