Provider Demographics
NPI:1740224120
Name:HINER, VIVIAN VANESSA (CRNA)
Entity Type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:VANESSA
Last Name:HINER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:VIVIAN
Other - Middle Name:V
Other - Last Name:HINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:601 4TH ST
Mailing Address - Street 2:POB 412
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:LA
Mailing Address - Zip Code:71366-0412
Mailing Address - Country:US
Mailing Address - Phone:318-301-9302
Mailing Address - Fax:
Practice Address - Street 1:4642 N LOOP 289
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-2409
Practice Address - Country:US
Practice Address - Phone:806-788-0040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN592557367500000X
LARN053155 APO3458367500000X
NY604338367500000X
FLARNP9276571367500000X
TXAP108242367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102558850 0001Medicaid
PA050514OtherMEDICARE GROUP #
1007307260035OtherMEDICAID GROUP #
PA124228P1KMedicare PIN