Healthcare Provider Details

I. General information

NPI: 1871642397
Provider Name (Legal Business Name): DEBRA JOAN HINES R.N., P.H.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 EVANS AVE
SAN FRANCISCO CA
94124-1705
US

IV. Provider business mailing address

142 DE SOTO ST
SAN FRANCISCO CA
94127-2813
US

V. Phone/Fax

Practice location:
  • Phone: 415-206-7639
  • Fax:
Mailing address:
  • Phone: 415-206-7639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number217875
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: