1699091694 NPI number — MRS. JEANNINE LAVONNE HINDS M.D., LAC

Table of content: MRS. JEANNINE LAVONNE HINDS M.D., LAC (NPI 1699091694)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699091694 NPI number — MRS. JEANNINE LAVONNE HINDS M.D., LAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HINDS
Provider First Name:
JEANNINE
Provider Middle Name:
LAVONNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.D., LAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DANDRIDGE
Provider Other First Name:
JEANNINE
Provider Other Middle Name:
LAVONNE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1699091694
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8485 E MCDONALD DR # 214
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85250-6335
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-363-7250
Provider Business Mailing Address Fax Number:
936-244-4643

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3501 N SCOTTSDALE RD STE 280
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85251-5650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-363-7250
Provider Business Practice Location Address Fax Number:
936-244-4643
Provider Enumeration Date:
04/15/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  48018 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)