Healthcare Provider Details

I. General information

NPI: 1992328371
Provider Name (Legal Business Name): PAULA LYNN HILL RN, BSN, ACDES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2020
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 SHAFFER ST
KALAMAZOO MI
49048-1604
US

IV. Provider business mailing address

1232 WARWICK ST
PORTAGE MI
49024-2693
US

V. Phone/Fax

Practice location:
  • Phone: 269-382-9820
  • Fax:
Mailing address:
  • Phone: 269-443-3984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number4704231330
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number4707231330
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: