Healthcare Provider Details

I. General information

NPI: 1235244468
Provider Name (Legal Business Name): JAMES G HILLIARD CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAMES HILLIARD CRNA

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 05/17/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CEDAR ST
NEW HAVEN CT
06510-3206
US

IV. Provider business mailing address

333 CEDAR ST
NEW HAVEN CT
06510-3206
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-2802
  • Fax: 203-785-6664
Mailing address:
  • Phone: 203-785-2802
  • Fax: 203-785-6664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN66968
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9414
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: