Healthcare Provider Details

I. General information

NPI: 1134697667
Provider Name (Legal Business Name): RACHEL LEE HILTZ BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2018
Last Update Date: 11/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N WEST AVE
JACKSON MI
49202-2179
US

IV. Provider business mailing address

1200 N WEST AVE
JACKSON MI
49202-2179
US

V. Phone/Fax

Practice location:
  • Phone: 517-789-1291
  • Fax: 517-796-4575
Mailing address:
  • Phone: 517-789-1291
  • Fax: 517-796-4575

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: