Healthcare Provider Details

I. General information

NPI: 1336322122
Provider Name (Legal Business Name): MS. MAPLE JEAN HILLIARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6602 PIKE VIEW DR
INDIANAPOLIS IN
46268-4470
US

IV. Provider business mailing address

6602 PIKE VIEW DR
INDIANAPOLIS IN
46268-4470
US

V. Phone/Fax

Practice location:
  • Phone: 317-731-6454
  • Fax: 317-731-6454
Mailing address:
  • Phone: 317-731-6454
  • Fax: 317-731-6454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: