Individual
MS. JACQUELINE RAE HINER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
117 W ELM ST, LAMAR, CO 81052-2701
(719) 691-1941
(719) 691-2132
Mailing address
117 W ELM ST, LAMAR, CO 81052-2701
(719) 691-1941
(719) 691-2132
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
04S685
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30854369
—
CO
Enumeration date
10/06/2020
Last updated
04/15/2021
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