Provider Demographics
NPI:1992931257
Name:HINES, ETHEL DELORES (CNA)
Entity type:Individual
Prefix:MRS
First Name:ETHEL
Middle Name:DELORES
Last Name:HINES
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 MEADOWVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-5314
Mailing Address - Country:US
Mailing Address - Phone:410-444-1529
Mailing Address - Fax:
Practice Address - Street 1:2105 MEADOWVIEW DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-5314
Practice Address - Country:US
Practice Address - Phone:410-444-1529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA-00005701251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health