Provider Demographics
NPI:1588765374
Name:HINES, LEONORILDA (NP)
Entity type:Individual
Prefix:
First Name:LEONORILDA
Middle Name:
Last Name:HINES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LEONORILDA
Other - Middle Name:
Other - Last Name:GUERRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 58538
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-8538
Mailing Address - Country:US
Mailing Address - Phone:281-724-8335
Mailing Address - Fax:832-932-5145
Practice Address - Street 1:600 N KOBAYASHI STE 310
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4841
Practice Address - Country:US
Practice Address - Phone:281-724-8335
Practice Address - Fax:832-932-5145
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP114970363L00000X, 363LF0000X
TX641882363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB140394OtherMEDICARE INDIVIDUAL PTAN