Healthcare Provider Details

I. General information

NPI: 1881276616
Provider Name (Legal Business Name): GLORIA HINES CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13211 CRYSTAL AVE
GRANDVIEW MO
64030-3336
US

IV. Provider business mailing address

4021 E 115TH ST
KANSAS CITY MO
64137-2301
US

V. Phone/Fax

Practice location:
  • Phone: 816-535-0307
  • Fax:
Mailing address:
  • Phone: 816-882-2518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number21040016
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: