MEDICARE: MS. GLORIA D HINKINS RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	85502630	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	39977500	OTHER	WI	PROVIDER NUMBER

General Provider Information

NPI Number	:	1598722613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GLORIA D HINKINS RN

Provider Business Mailing Address
First Line	:	5700 N DEXTER AVE
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53209-4212
Country	:	US
Telephone Number	:	414-527-0131
Fax Number	:	414-527-0131

Provider Business Practice Location Address
First Line	:	5700 N DEXTER AVE
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53209-4212
Country	:	US
Telephone Number	:	414-527-0131
Fax Number	:	414-527-0131

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	07/08/2007

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