Provider Demographics
NPI:1730898396
Name:HINES, MARIANA ISABEL CORPUS (APRN)
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:ISABEL CORPUS
Last Name:HINES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARIANA
Other - Middle Name:ISABEL
Other - Last Name:CORPUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 735044
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5044
Mailing Address - Country:US
Mailing Address - Phone:800-326-2250
Mailing Address - Fax:
Practice Address - Street 1:818 FOREST LN
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:WI
Practice Address - Zip Code:53185-4585
Practice Address - Country:US
Practice Address - Phone:262-514-8199
Practice Address - Fax:262-514-3851
Is Sole Proprietor?:No
Enumeration Date:2022-11-22
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16422363L00000X
FL11020982363LF0000X
NC5019446363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100333585Medicaid
NC1730898396Medicaid