Provider Demographics
NPI:1518613785
Name:HILL, COURTLAND DON SR (CNA)
Entity Type:Individual
Prefix:
First Name:COURTLAND
Middle Name:DON
Last Name:HILL
Suffix:SR
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 HERITAGE PARK DR APT 248
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-7548
Mailing Address - Country:US
Mailing Address - Phone:405-923-8630
Mailing Address - Fax:
Practice Address - Street 1:3524 NW 56TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4518
Practice Address - Country:US
Practice Address - Phone:405-606-6937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-26
Last Update Date:2022-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37V961120410376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide