Provider Demographics
NPI:1710133921
Name:HINES, MICHELLE T (CNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:T
Last Name:HINES
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:T
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4700 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-5604
Mailing Address - Country:US
Mailing Address - Phone:404-403-3010
Mailing Address - Fax:
Practice Address - Street 1:324 E 35TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-4580
Practice Address - Country:US
Practice Address - Phone:612-827-7181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR183674-9363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health