Healthcare Provider Details

I. General information

NPI: 1689228538
Provider Name (Legal Business Name): DEJA LEA HILLMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
MIDDLETOWN OH
45005-2584
US

IV. Provider business mailing address

1 MEDICAL CENTER DR
MIDDLETOWN OH
45005-1066
US

V. Phone/Fax

Practice location:
  • Phone: 513-974-5017
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberAPRN.CNP.025276
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: