Healthcare Provider Details

I. General information

NPI: 1154621175
Provider Name (Legal Business Name): LORI LYNN HINDS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 44TH ST SE SUITE A
GRAND RAPIDS MI
49548-4371
US

IV. Provider business mailing address

9945 FOREST RIDGE LN
MIDDLEVILLE MI
49333-8570
US

V. Phone/Fax

Practice location:
  • Phone: 616-531-9750
  • Fax:
Mailing address:
  • Phone: 616-312-5044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601003298
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: