Healthcare Provider Details

I. General information

NPI: 1235696436
Provider Name (Legal Business Name): LAURA HILLARD FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA WOLFGANG FNP-BC

II. Dates (important events)

Enumeration Date: 02/23/2019
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3022 S MARTIN LUTHER KING JR BLVD
LANSING MI
48910-2695
US

IV. Provider business mailing address

PO BOX 746723
ATLANTA GA
30374-6723
US

V. Phone/Fax

Practice location:
  • Phone: 517-253-1304
  • Fax:
Mailing address:
  • Phone: 127-339-7303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704253317
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: