Provider Demographics
NPI:1790787539
Name:HINES, ANNE T (PA)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:T
Last Name:HINES
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-479-3514
Mailing Address - Fax:260-479-3520
Practice Address - Street 1:7910 W JEFFERSON BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4159
Practice Address - Country:US
Practice Address - Phone:260-436-2424
Practice Address - Fax:260-436-2922
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2020-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN10000159A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN970014263OtherRR MEDICARE
OHPA23982Medicare PIN
IN149080HMedicare PIN
S47452Medicare UPIN
IN970014263Medicare PIN