Healthcare Provider Details

I. General information

NPI: 1497946834
Provider Name (Legal Business Name): TERESA JEAN HINZ CRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TERRY JEAN HINZ CRT

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 08/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8575 W FOREST HOME AVE STE 140
GREENFIELD WI
53228-3417
US

IV. Provider business mailing address

8575 W FOREST HOME AVE STE 140
GREENFIELD WI
53228-3417
US

V. Phone/Fax

Practice location:
  • Phone: 414-425-8400
  • Fax: 414-425-8449
Mailing address:
  • Phone: 414-425-8400
  • Fax: 414-425-8449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number3523028
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: