Provider Demographics
NPI:1700052578
Name:HILLIARD, LINDA R
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:R
Last Name:HILLIARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 JOHN SMALL AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-4549
Mailing Address - Country:US
Mailing Address - Phone:252-948-1381
Mailing Address - Fax:252-948-1382
Practice Address - Street 1:704 JOHN SMALL AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-4549
Practice Address - Country:US
Practice Address - Phone:252-948-1381
Practice Address - Fax:252-948-1382
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator