Provider Demographics
NPI:1093023061
Name:HILLS, MICHELE LYN (LPN)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:LYN
Last Name:HILLS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 E GATE
Mailing Address - Street 2:
Mailing Address - City:COPIAGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11726-3213
Mailing Address - Country:US
Mailing Address - Phone:631-682-7375
Mailing Address - Fax:
Practice Address - Street 1:21 E GATE
Practice Address - Street 2:
Practice Address - City:COPIAGUE
Practice Address - State:NY
Practice Address - Zip Code:11726-3213
Practice Address - Country:US
Practice Address - Phone:631-682-7375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY274401-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse