Basic Information
| Provider Information | |||||||||
| NPI: | 1699091694 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HINDS | ||||||||
| FirstName: | JEANNINE | ||||||||
| MiddleName: | LAVONNE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DANDRIDGE | ||||||||
| OtherFirstName: | JEANNINE | ||||||||
| OtherMiddleName: | LAVONNE | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2500 W UTOPIA RD | ||||||||
| Address2: | STE. 100 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850274171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6234346200 | ||||||||
| FaxNumber: | 6234346164 | ||||||||
| Practice Location | |||||||||
| Address1: | 4131 N 24TH ST | ||||||||
| Address2: | STE. B102 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850166262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029556632 | ||||||||
| FaxNumber: | 6023811341 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2010 | ||||||||
| LastUpdateDate: | 09/27/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 48018 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.