Healthcare Provider Details

I. General information

NPI: 1730898396
Provider Name (Legal Business Name): MARIANA ISABEL CORPUS HINES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIANA ISABEL CORPUS

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 FOREST LN
WATERFORD WI
53185-4585
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 262-514-8199
  • Fax: 262-514-3851
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number16422
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11020982
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5019446
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: