Provider Demographics
NPI:1437112703
Name:HINES, JENNIFER GUEST (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:GUEST
Last Name:HINES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE S # MS 21110Q
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:451 NORTH DUNLAP STREET
Practice Address - Street 2:MAIL STOP 32700A
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4621
Practice Address - Country:US
Practice Address - Phone:651-999-4700
Practice Address - Fax:651-999-4781
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48141207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E30752Medicare UPIN
MN110010564Medicare ID - Type Unspecified