Provider Demographics
NPI:1851473623
Name:HINESLEY, CHELA MARIE (PAC RD)
Entity Type:Individual
Prefix:
First Name:CHELA
Middle Name:MARIE
Last Name:HINESLEY
Suffix:
Gender:F
Credentials:PAC RD
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 3768
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95344-3768
Mailing Address - Country:US
Mailing Address - Phone:209-722-9066
Mailing Address - Fax:209-383-1522
Practice Address - Street 1:535 W 25TH ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-2801
Practice Address - Country:US
Practice Address - Phone:209-722-9066
Practice Address - Fax:209-383-1522
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13555363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGE806ZMedicare PIN
CAQ74767Medicare UPIN