Provider Demographics
NPI:1962410555
Name:HINES, DONNA (PA)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:HINES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3399 POLLOCK RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8393
Mailing Address - Country:US
Mailing Address - Phone:810-603-0170
Mailing Address - Fax:810-579-1705
Practice Address - Street 1:3399 POLLOCK RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8393
Practice Address - Country:US
Practice Address - Phone:810-603-0170
Practice Address - Fax:810-579-1705
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIOM34870P01363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI586771Medicare UPIN