Provider Demographics
NPI:1013191899
Name:HILLIS, LINDA N (LAC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:N
Last Name:HILLIS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 UNIVERSITY DR
Mailing Address - Street 2:106
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2168
Mailing Address - Country:US
Mailing Address - Phone:817-703-7601
Mailing Address - Fax:
Practice Address - Street 1:601 UNIVERSITY DR
Practice Address - Street 2:106
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2168
Practice Address - Country:US
Practice Address - Phone:817-703-7601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX000768171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist