Healthcare Provider Details

I. General information

NPI: 1447333083
Provider Name (Legal Business Name): NICHOLAS JOSEPH HILL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 03/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 NORTH SECOND ST
CLINTON MO
64735-1192
US

IV. Provider business mailing address

141 NE 770
CLINTON MO
64735
US

V. Phone/Fax

Practice location:
  • Phone: 660-890-7103
  • Fax: 660-885-8496
Mailing address:
  • Phone: 660-885-2970
  • Fax: 660-885-8496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number080112
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: