Provider Demographics
NPI:1417651837
Name:HILT, MILISA SUE (STNA)
Entity Type:Individual
Prefix:
First Name:MILISA
Middle Name:SUE
Last Name:HILT
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552 BLAINE AVE # 5
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-4828
Mailing Address - Country:US
Mailing Address - Phone:740-244-4786
Mailing Address - Fax:
Practice Address - Street 1:552 BLAINE AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-4828
Practice Address - Country:US
Practice Address - Phone:740-244-4786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRS7084363747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant