Provider Demographics
NPI:1336142959
Name:HENDERSON-HINES, NANCY (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:HENDERSON-HINES
Suffix:
Gender:F
Credentials:MD
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 40908
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28309-0908
Mailing Address - Country:US
Mailing Address - Phone:910-609-6448
Mailing Address - Fax:910-609-7040
Practice Address - Street 1:6387 RAMSEY ST
Practice Address - Street 2:SUITE 210
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-9420
Practice Address - Country:US
Practice Address - Phone:910-609-3920
Practice Address - Fax:910-321-6221
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36731207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8941609Medicaid
NC2199313DMedicare ID - Type UnspecifiedPROVIDER NUMBER
NC8941609Medicaid
NCF82549Medicare UPIN
NC2199313AMedicare ID - Type UnspecifiedPROVIDER NUMBER
NC2199313CMedicare ID - Type UnspecifiedPROVIDER NUMBER