Provider Demographics
NPI:1760477616
Name:HILL, HELENA M (PAC)
Entity Type:Individual
Prefix:
First Name:HELENA
Middle Name:M
Last Name:HILL
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 785
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73502
Mailing Address - Country:US
Mailing Address - Phone:580-357-9984
Mailing Address - Fax:580-357-3277
Practice Address - Street 1:624 S COBB LAKE
Practice Address - Street 2:
Practice Address - City:APACHE
Practice Address - State:OK
Practice Address - Zip Code:73006
Practice Address - Country:US
Practice Address - Phone:580-588-3257
Practice Address - Fax:580-588-3265
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK850363AM0700X
OKPA850363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKS50356Medicare UPIN
OK373422Medicare Oscar/Certification