Healthcare Provider Details

I. General information

NPI: 1467552612
Provider Name (Legal Business Name): KAREEN NOELLE HINES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 E SANILAC RD
SANDUSKY MI
48471-1383
US

IV. Provider business mailing address

6595 GALBRAITH LINE RD
CROSWELL MI
48422-9123
US

V. Phone/Fax

Practice location:
  • Phone: 810-648-9395
  • Fax:
Mailing address:
  • Phone: 810-679-9919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number4704242022
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: