Provider Demographics
NPI:1871644930
Name:HINES, ANDREA LESLIE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LESLIE
Last Name:HINES
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:LESLIE
Other - Last Name:FANNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:ROSEBUD IHS HOSPITAL
Mailing Address - City:ROSEBUD
Mailing Address - State:SD
Mailing Address - Zip Code:57570-0400
Mailing Address - Country:US
Mailing Address - Phone:605-747-2231
Mailing Address - Fax:605-747-2216
Practice Address - Street 1:SOLDIER CREEK ROAD
Practice Address - Street 2:ROSEBUD IHS HOSPITAL
Practice Address - City:ROSEBUD
Practice Address - State:SD
Practice Address - Zip Code:57570
Practice Address - Country:US
Practice Address - Phone:605-747-2231
Practice Address - Fax:605-747-2216
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR030630163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse