Provider Demographics
NPI:1922716836
Name:HILT, SAMANTHA ANN
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:ANN
Last Name:HILT
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 1:2215 FULLER RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-2303
Mailing Address - Country:US
Mailing Address - Phone:734-845-3096
Mailing Address - Fax:734-222-7174
Practice Address - Street 1:11111 SHADYWOOD DR
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-9248
Practice Address - Country:US
Practice Address - Phone:734-845-3096
Practice Address - Fax:734-222-7174
Is Sole Proprietor?:No
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704341369163WX0601X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0601XNursing Service ProvidersRegistered NurseOtorhinolaryngology & Head-Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704341369OtherVA