Individual
SHAWN MERLE HINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
205 N EAST AVE, JACKSON, MI 49201-1753
(517) 788-4963
Mailing address
6113 RIVERVIEW DR, JACKSON, MI 49203-5694
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704203852
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
053093
CRNA/AANA
—
Enumeration date
09/22/2006
Last updated
07/08/2007
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