Provider Demographics
NPI:1609891522
Name:HINES, SUSAN A (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:A
Last Name:HINES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3823 HIGHVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-6466
Mailing Address - Country:US
Mailing Address - Phone:704-650-8893
Mailing Address - Fax:
Practice Address - Street 1:3823 HIGHVIEW RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-6466
Practice Address - Country:US
Practice Address - Phone:704-650-8893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC900038363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8910948Medicaid
NC08010491OtherMEDICARE RAILROAD
NC10948OtherNCBCBS
NC08010491OtherMEDICARE RAILROAD
NC2804927AMedicare ID - Type Unspecified