Provider Demographics
NPI:1821660622
Name:HINTZMAN, JOHN HENRY
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HENRY
Last Name:HINTZMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25724 HARMON ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-3344
Mailing Address - Country:US
Mailing Address - Phone:810-278-0395
Mailing Address - Fax:
Practice Address - Street 1:25724 HARMON ST
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-3344
Practice Address - Country:US
Practice Address - Phone:810-278-0395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704311070163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse