Healthcare Provider Details

I. General information

NPI: 1992559975
Provider Name (Legal Business Name): CAROLINA M HYNDMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 W HORIZON RIDGE PKWY STE 121
HENDERSON NV
89052-5014
US

IV. Provider business mailing address

2900 W HORIZON RIDGE PKWY STE 121
HENDERSON NV
89052-5014
US

V. Phone/Fax

Practice location:
  • Phone: 702-281-1267
  • Fax:
Mailing address:
  • Phone: 702-281-1267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN50181
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: