Provider Demographics
NPI:1417453374
Name:HILL, HOLLY N (RN, BSN, IBCLC)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:N
Last Name:HILL
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 S 400 E
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-2057
Mailing Address - Country:US
Mailing Address - Phone:801-721-3577
Mailing Address - Fax:
Practice Address - Street 1:21 S 400 E
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-2057
Practice Address - Country:US
Practice Address - Phone:801-721-3577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-31
Last Update Date:2018-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTL-100985163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant