Healthcare Provider Details

I. General information

NPI: 1790136281
Provider Name (Legal Business Name): DEVIN HINES RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2016
Last Update Date: 06/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12512 TRIPLE OAKS DR
SAINT LOUIS MO
63128-2039
US

IV. Provider business mailing address

12512 TRIPLE OAKS DR
SAINT LOUIS MO
63128-2039
US

V. Phone/Fax

Practice location:
  • Phone: 618-960-0409
  • Fax:
Mailing address:
  • Phone: 618-960-0409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number2014016381
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: