Provider Demographics
NPI:1649847963
Name:HILLIS, JEFFERY PAUL (RN)
Entity type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:PAUL
Last Name:HILLIS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 CLAYTON RD STE B1,
Mailing Address - Street 2:#187
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-3161
Mailing Address - Country:US
Mailing Address - Phone:925-481-6830
Mailing Address - Fax:
Practice Address - Street 1:5100 CLAYTON RD STE B1,187
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-3161
Practice Address - Country:US
Practice Address - Phone:925-481-6830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-06
Last Update Date:2021-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390858163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse