Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 132483 | MO |
NPI | 1033477542 |
---|---|
Provider Name | Mrs. Heather Hynes |
First Address | Tuscumbia, MO 65082-2305 |
Second Address | Tuscumbia, MO 65082 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2012 |
Last Update Date | 03/05/2012 |