Provider Demographics
NPI:1790715886
Name:HILL, LORRAINE LEILANI (FNP)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:LEILANI
Last Name:HILL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LORRAINE
Other - Middle Name:LEILANI
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:320 BAWDEN ST
Mailing Address - Street 2:SUITE 313
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-6573
Mailing Address - Country:US
Mailing Address - Phone:907-220-9982
Mailing Address - Fax:907-220-9972
Practice Address - Street 1:320 BAWDEN ST
Practice Address - Street 2:SUITE 313
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-6573
Practice Address - Country:US
Practice Address - Phone:907-220-9982
Practice Address - Fax:907-220-9972
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK18345363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCL2696Medicaid
AK8EZ011Medicare ID - Type UnspecifiedFNP
AKS55327Medicare UPIN