Provider Demographics
NPI:1396618310
Name:HINES, SELENA MARIE (HCA)
Entity type:Individual
Prefix:
First Name:SELENA
Middle Name:MARIE
Last Name:HINES
Suffix:
Gender:F
Credentials:HCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:TONASKET
Mailing Address - State:WA
Mailing Address - Zip Code:98855-8830
Mailing Address - Country:US
Mailing Address - Phone:509-557-9324
Mailing Address - Fax:
Practice Address - Street 1:220 E 3RD ST
Practice Address - Street 2:
Practice Address - City:TONASKET
Practice Address - State:WA
Practice Address - Zip Code:98855-8830
Practice Address - Country:US
Practice Address - Phone:509-557-9324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHMCC.HM.60734565374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide