Provider Demographics
NPI:1659066652
Name:MOINIPOUR, HILLARY LEE (NP-C)
Entity Type:Individual
Prefix:
First Name:HILLARY
Middle Name:LEE
Last Name:MOINIPOUR
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:HILLARY
Other - Middle Name:
Other - Last Name:MOINIPOUR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1508 HARDEMAN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-1471
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1508 HARDEMAN AVE STE A
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-1471
Practice Address - Country:US
Practice Address - Phone:478-742-3704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN228167363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily