Provider Demographics
NPI:1801605134
Name:HIATT, LAURIE
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:HIATT
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 1:46264 COUNTY ROAD 374
Mailing Address - Street 2:
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-9617
Mailing Address - Country:US
Mailing Address - Phone:269-500-1569
Mailing Address - Fax:
Practice Address - Street 1:46264 COUNTY ROAD 374
Practice Address - Street 2:
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079-9617
Practice Address - Country:US
Practice Address - Phone:269-500-1569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide