MEDICARE: CARLY HINES RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN70020644	WA
2	171M00000X	Case Manager/Care Coordinator	RN70020644	WA

General Provider Information

NPI Number	:	1154797256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLY HINES RN

Provider Business Mailing Address
First Line	:	PO BOX 34703
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98124-1703
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 N 18TH LAVENTURE RD
Second Line	:	SUITE A
City	:	MOUNT VERNON
State	:	WA
Zip	:	98273
Country	:	US
Telephone Number	:	360-588-5570
Fax Number	:	360-588-5562

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2015
Last Update Date	:	03/24/2026

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Directions to “ CARLY HINES RN” Practice Location

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