Provider Demographics
NPI:1770794505
Name:HINES, RUTH (APRN,BC)
Entity type:Individual
Prefix:MS
First Name:RUTH
Middle Name:
Last Name:HINES
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-5910
Mailing Address - Country:US
Mailing Address - Phone:617-267-9084
Mailing Address - Fax:
Practice Address - Street 1:1234 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:ROXBURY CROSSING
Practice Address - State:MA
Practice Address - Zip Code:02120-3423
Practice Address - Country:US
Practice Address - Phone:617-427-0060
Practice Address - Fax:617-933-7427
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA94788363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health