Healthcare Provider Details

I. General information

NPI: 1285966275
Provider Name (Legal Business Name): MS. MARY PAT HINES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6816 NE HIGHWAY 99
VANCOUVER WA
98665-0547
US

IV. Provider business mailing address

6816 NE HIGHWAY 99
VANCOUVER WA
98665-0547
US

V. Phone/Fax

Practice location:
  • Phone: 608-432-5464
  • Fax:
Mailing address:
  • Phone: 608-432-5464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60133384
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: