Provider Demographics
NPI:1235696436
Name:HILLARD, LAURA (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:HILLARD
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:WOLFGANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:4042 MISTY MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:SARANAC
Mailing Address - State:MI
Mailing Address - Zip Code:48881-8724
Mailing Address - Country:US
Mailing Address - Phone:517-819-7229
Mailing Address - Fax:
Practice Address - Street 1:4042 MISTY MEADOWS DR
Practice Address - Street 2:
Practice Address - City:SARANAC
Practice Address - State:MI
Practice Address - Zip Code:48881-8724
Practice Address - Country:US
Practice Address - Phone:517-819-7229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-23
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704253317363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily