Provider Demographics
NPI:1174038335
Name:HILTON, LISA NICOLE (CNA)
Entity Type:Individual
Prefix:MISS
First Name:LISA
Middle Name:NICOLE
Last Name:HILTON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 S SPIELMAN RD
Mailing Address - Street 2:
Mailing Address - City:PECATONICA
Mailing Address - State:IL
Mailing Address - Zip Code:61063-9366
Mailing Address - Country:US
Mailing Address - Phone:815-985-2186
Mailing Address - Fax:
Practice Address - Street 1:4523 WESTWIND DR
Practice Address - Street 2:
Practice Address - City:WINNEBAGO
Practice Address - State:IL
Practice Address - Zip Code:61088-8009
Practice Address - Country:US
Practice Address - Phone:815-985-2186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-11
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide