Basic Information
| Provider Information | |||||||||
| NPI: | 1346246857 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HINES | ||||||||
| FirstName: | MAGDALENE | ||||||||
| MiddleName: | HILEMAN | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 224 W EXCHANGE ST | ||||||||
| Address2: | STE 220 | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443021704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303446401 | ||||||||
| FaxNumber: | 3303441714 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 AKRON GENERAL AVE | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443072432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303446000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2005 | ||||||||
| LastUpdateDate: | 05/19/2016 | ||||||||
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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 | 367500000X | RN 189818 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 0847294 | 05 | OH | MEDICAID | 000000264874 | 01 | OH | ANTHEM PIN | OTHER |