Provider Demographics
NPI:1558332148
Name:HILL, NINA
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:HILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN, APRN, BC-FNP
Mailing Address - Street 1:224 N FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-5626
Mailing Address - Country:US
Mailing Address - Phone:573-332-0121
Mailing Address - Fax:573-332-0121
Practice Address - Street 1:224 N FREDERICK ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-5626
Practice Address - Country:US
Practice Address - Phone:573-332-0121
Practice Address - Fax:573-332-0121
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO099891363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP84950Medicare UPIN
MO009012378Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER