Healthcare Provider Details

I. General information

NPI: 1639538986
Provider Name (Legal Business Name): MR. MARK RAYMOND HINDE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2016
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4406 E MAIN ST STE 106
MESA AZ
85205-7910
US

IV. Provider business mailing address

4406 E MAIN ST STE 106
MESA AZ
85205-7910
US

V. Phone/Fax

Practice location:
  • Phone: 480-547-6957
  • Fax: 602-603-5595
Mailing address:
  • Phone: 480-547-6957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP8419
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10757
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: