Provider Demographics
NPI:1679049944
Name:HINTON, TAKEDA
Entity Type:Individual
Prefix:
First Name:TAKEDA
Middle Name:
Last Name:HINTON
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:PO BOX 532
Mailing Address - Street 2:
Mailing Address - City:COURTLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23837-0532
Mailing Address - Country:US
Mailing Address - Phone:757-556-7314
Mailing Address - Fax:
Practice Address - Street 1:22086 BATEMAN ST
Practice Address - Street 2:
Practice Address - City:COURTLAND
Practice Address - State:VA
Practice Address - Zip Code:23837-1005
Practice Address - Country:US
Practice Address - Phone:757-556-7314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-15
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA83-1948065171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor