Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 54258 | TN |
Y | 2080P0203X | Pediatric Critical Care Doctor | 54258 | TN |
NPI | 1275854259 |
---|---|
Provider Name | Dr. Melissa Ruth Hines |
First Address | Memphis, TN 38105-3678 |
Second Address | Memphis, TN 38105-3678 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2010 |
Last Update Date | 19/11/2018 |