Provider Demographics
NPI:1750708764
Name:HINZ, VICKY RENEE (RN, BSN)
Entity type:Individual
Prefix:MRS
First Name:VICKY
Middle Name:RENEE
Last Name:HINZ
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 MADGE CT
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-9419
Mailing Address - Country:US
Mailing Address - Phone:440-915-2462
Mailing Address - Fax:
Practice Address - Street 1:1931 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-5482
Practice Address - Country:US
Practice Address - Phone:843-915-8912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC212517163WC0400X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WC0400XNursing Service ProvidersRegistered NurseCase Management