Healthcare Provider Details

I. General information

NPI: 1164758652
Provider Name (Legal Business Name): RENATA HOLLAND HILLMAN CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2009
Last Update Date: 10/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7248 BRUSHY CREEK RD
LUCEDALE MS
39452-8820
US

IV. Provider business mailing address

7248 BRUSHY CREEK RD
LUCEDALE MS
39452-8820
US

V. Phone/Fax

Practice location:
  • Phone: 251-463-2425
  • Fax:
Mailing address:
  • Phone: 251-463-2425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number08110005
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: