Healthcare Provider Details

I. General information

NPI: 1518613785
Provider Name (Legal Business Name): COURTLAND DON HILL SR. CNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2022
Last Update Date: 02/26/2022
Certification Date: 02/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3524 NW 56TH ST
OKLAHOMA CITY OK
73112-4518
US

IV. Provider business mailing address

1916 HERITAGE PARK DR APT 248
OKLAHOMA CITY OK
73120-7548
US

V. Phone/Fax

Practice location:
  • Phone: 405-606-6937
  • Fax:
Mailing address:
  • Phone: 405-923-8630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number37V961120410
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: