Healthcare Provider Details

I. General information

NPI: 1770361578
Provider Name (Legal Business Name): DEVILYN HINDMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2023
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5957B KAMIAKIN TRL
FAIRCHILD AIR FORCE BASE WA
99011-2210
US

IV. Provider business mailing address

5957B KAMIAKIN TRL
FAIRCHILD AIR FORCE BASE WA
99011-2210
US

V. Phone/Fax

Practice location:
  • Phone: 719-291-1004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: