Provider Demographics
NPI:1154840353
Name:HINES, MATTHEW J (ARNP)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:HINES
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52353-0909
Mailing Address - Country:US
Mailing Address - Phone:319-653-5481
Mailing Address - Fax:319-863-3977
Practice Address - Street 1:400 EAST POLK STREET
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IA
Practice Address - Zip Code:52353-1237
Practice Address - Country:US
Practice Address - Phone:319-653-5481
Practice Address - Fax:319-353-8073
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH126919363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care