Provider Demographics
NPI:1679160048
Name:HINES, JESSICA (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:HINES
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 PARK MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28570-8199
Mailing Address - Country:US
Mailing Address - Phone:910-984-6020
Mailing Address - Fax:
Practice Address - Street 1:540 PARK MEADOWS DR
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NC
Practice Address - Zip Code:28570-8199
Practice Address - Country:US
Practice Address - Phone:910-984-6020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL-301493163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant