Provider Demographics
NPI:1346883105
Name:HINO, SUSAN ANDREA (RN)
Entity Type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:ANDREA
Last Name:HINO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 GLENCROFT DR
Mailing Address - Street 2:
Mailing Address - City:WINGATE
Mailing Address - State:NC
Mailing Address - Zip Code:28174-7801
Mailing Address - Country:US
Mailing Address - Phone:704-221-7354
Mailing Address - Fax:
Practice Address - Street 1:3901 HIGHWAY 74 E STE B
Practice Address - Street 2:
Practice Address - City:WINGATE
Practice Address - State:NC
Practice Address - Zip Code:28174-6791
Practice Address - Country:US
Practice Address - Phone:704-233-7433
Practice Address - Fax:704-324-0026
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care