Healthcare Provider Details

I. General information

NPI: 1215890041
Provider Name (Legal Business Name): NADEGE HILLIARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1443 HARTFORD AVE
JOHNSTON RI
02919-3224
US

IV. Provider business mailing address

1443 HARTFORD AVE
JOHNSTON RI
02919-3224
US

V. Phone/Fax

Practice location:
  • Phone: 401-724-8400
  • Fax:
Mailing address:
  • Phone: 401-724-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number43379
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: