Healthcare Provider Details

I. General information

NPI: 1841748241
Provider Name (Legal Business Name): ASHLEE HILLIARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N FLORIDA AVE APT A
ALAMOGORDO NM
88310-5408
US

IV. Provider business mailing address

2500 NORTH FLORIDA APT A
ALAMOGORDO NM
88310
US

V. Phone/Fax

Practice location:
  • Phone: 575-551-1289
  • Fax:
Mailing address:
  • Phone: 575-551-1289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number247200000X
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: