Individual
BRENDA F HINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2105 W GENESEE ST, SYRACUSE, NY 13219-1698
(315) 468-3239
(315) 468-2917
Mailing address
521 SALT SPRINGS RD, SYRACUSE, NY 13224-1528
(315) 278-7109
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
286530
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
286530
LPN LICENSE
NY
Enumeration date
06/18/2012
Last updated
06/18/2012
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