Healthcare Provider Details

I. General information

NPI: 1629233564
Provider Name (Legal Business Name): LYNDA LOU HILLMAN INDEPENDANT PROVIDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5631 WESTBROOK ST SE
MAGNOLIA OH
44643-9745
US

IV. Provider business mailing address

5631 WESTBROOK ST SE
MAGNOLIA OH
44643-9745
US

V. Phone/Fax

Practice location:
  • Phone: 330-866-4377
  • Fax:
Mailing address:
  • Phone: 330-866-4377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number2416424
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: