Provider Demographics
NPI:1033998315
Name:HILL, LISA M (CNM)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:HILL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9645 S YORKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-9635
Mailing Address - Country:US
Mailing Address - Phone:801-964-3865
Mailing Address - Fax:
Practice Address - Street 1:3336 S PIONEER PKWY STE 301
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-2073
Practice Address - Country:US
Practice Address - Phone:801-964-3865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6755837-3102163W00000X
UT6755837-4402367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse