Provider Demographics
NPI:1477300747
Name:HINES, SHANNON MARIE
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:MARIE
Last Name:HINES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 HUMBUG RD
Mailing Address - Street 2:
Mailing Address - City:YREKA
Mailing Address - State:CA
Mailing Address - Zip Code:96097-2008
Mailing Address - Country:US
Mailing Address - Phone:530-340-4607
Mailing Address - Fax:
Practice Address - Street 1:322 W CENTER ST STE 6
Practice Address - Street 2:
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097-2900
Practice Address - Country:US
Practice Address - Phone:530-841-7190
Practice Address - Fax:530-841-7194
Is Sole Proprietor?:No
Enumeration Date:2024-05-03
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator