Healthcare Provider Details

I. General information

NPI: 1467597047
Provider Name (Legal Business Name): JEAN A. HINLICKY M. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 CAMINO DE LA LUZ
SANTA FE NM
87505-5925
US

IV. Provider business mailing address

631 CAMINO DE LA LUZ
SANTA FE NM
87505-5925
US

V. Phone/Fax

Practice location:
  • Phone: 505-690-2357
  • Fax:
Mailing address:
  • Phone: 505-690-2357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD2015-0410
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: