Provider Demographics
NPI:1063072452
Name:HINES, TIMIA SHUNICE
Entity type:Individual
Prefix:
First Name:TIMIA
Middle Name:SHUNICE
Last Name:HINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIMIA
Other - Middle Name:S
Other - Last Name:HINES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:15534 TURLINGTON AVE APT 2N
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:IL
Mailing Address - Zip Code:60426-4374
Mailing Address - Country:US
Mailing Address - Phone:708-663-1269
Mailing Address - Fax:708-663-1269
Practice Address - Street 1:15534 TURLINGTON AVE APT 2N
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-4374
Practice Address - Country:US
Practice Address - Phone:708-663-1269
Practice Address - Fax:708-663-1269
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)