MEDICARE: ELIZABETH ANN HINES APRN,BC

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	363LF0000X	Family Nurse Practitioner	28121880	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619967098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ANN HINES APRN,BC

Provider Business Mailing Address
First Line	:	2723 S 7TH ST
Second Line	:	SUITE A
City	:	TERRE HAUTE
State	:	IN
Zip	:	47802-3584
Country	:	US
Telephone Number	:	812-238-1730
Fax Number	:	812-242-1565

Provider Business Practice Location Address
First Line	:	115 S MURPHY AVE
Second Line	:	SUITE A
City	:	BRAZIL
State	:	IN
Zip	:	47834-8296
Country	:	US
Telephone Number	:	812-442-2100
Fax Number	:	812-446-4409

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

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	10/31/2012

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