Healthcare Provider Details

I. General information

NPI: 1407261050
Provider Name (Legal Business Name): LAQUITA HILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28660 SOUTHFIELD RD STE 201
LATHRUP VILLAGE MI
48076-2729
US

IV. Provider business mailing address

1531 S EDSEL ST
DETROIT MI
48217-1207
US

V. Phone/Fax

Practice location:
  • Phone: 248-832-1475
  • Fax:
Mailing address:
  • Phone: 313-914-7686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number4704381284
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703109520
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: