Healthcare Provider Details

I. General information

NPI: 1093112112
Provider Name (Legal Business Name): MICHELE HILLS PA-C, MMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2014
Last Update Date: 12/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 W 100TH AVE
THORNTON CO
80260-8065
US

IV. Provider business mailing address

1700 W 100TH AVE
THORNTON CO
80260-8065
US

V. Phone/Fax

Practice location:
  • Phone: 720-515-9112
  • Fax: 888-958-5968
Mailing address:
  • Phone: 720-515-9112
  • Fax: 888-958-5968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0004178
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: