Provider Demographics
NPI:1891569091
Name:HINES, LINA ANN (RN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:LINA
Middle Name:ANN
Last Name:HINES
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3521 BLEAK HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:EARLYSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22936-2212
Mailing Address - Country:US
Mailing Address - Phone:201-421-7142
Mailing Address - Fax:
Practice Address - Street 1:3521 BLEAK HOUSE RD
Practice Address - Street 2:
Practice Address - City:EARLYSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22936-2212
Practice Address - Country:US
Practice Address - Phone:201-421-7142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001180113163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant