Provider Demographics
NPI:1265866123
Name:HILL, DEIDRE (FNP)
Entity Type:Individual
Prefix:
First Name:DEIDRE
Middle Name:
Last Name:HILL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3049 S 700 W
Mailing Address - Street 2:
Mailing Address - City:OWENSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47665-9372
Mailing Address - Country:US
Mailing Address - Phone:812-706-6640
Mailing Address - Fax:812-729-7582
Practice Address - Street 1:3049 S 700 W
Practice Address - Street 2:
Practice Address - City:OWENSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47665-9372
Practice Address - Country:US
Practice Address - Phone:812-706-6640
Practice Address - Fax:812-729-7582
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004586A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000835866OtherANTHEM
INP01257644OtherRAILROAD MEDICARE
IN146080004Medicare PIN