Provider Demographics
NPI:1922421411
Name:HINER, CECILY CARROLL (RD, CD)
Entity Type:Individual
Prefix:MS
First Name:CECILY
Middle Name:CARROLL
Last Name:HINER
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 SPRING ST
Mailing Address - Street 2:BUILDING A, SUITE 311
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53405-1667
Mailing Address - Country:US
Mailing Address - Phone:262-687-6345
Mailing Address - Fax:262-687-6344
Practice Address - Street 1:3805 SPRING ST
Practice Address - Street 2:BUILDING A, SUITE 311
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53405-1667
Practice Address - Country:US
Practice Address - Phone:262-687-6345
Practice Address - Fax:262-687-6344
Is Sole Proprietor?:No
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2191-029133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered