Healthcare Provider Details

I. General information

NPI: 1023162021
Provider Name (Legal Business Name): DENNIS M HINES NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date: 10/26/2015
Reactivation Date: 10/26/2015

III. Provider practice location address

1880 OCEAN ST
MARSHFIELD MA
02050-4906
US

IV. Provider business mailing address

1880 OCEAN ST
MARSHFIELD MA
02050-4906
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax: 401-652-9787
Mailing address:
  • Phone: 866-389-2727
  • Fax: 401-652-9787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number149531
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN1939
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: