Healthcare Provider Details

I. General information

NPI: 1124108667
Provider Name (Legal Business Name): CAROL L HILL APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 S WASHINGTON AVE
LANSING MI
48910-0828
US

IV. Provider business mailing address

1150 BENNINGTON DR
LANSING MI
48917-3921
US

V. Phone/Fax

Practice location:
  • Phone: 517-267-3925
  • Fax: 517-267-3593
Mailing address:
  • Phone: 517-323-0533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number47040865964
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: