Healthcare Provider Details

I. General information

NPI: 1427602705
Provider Name (Legal Business Name): LAURA HILLIARD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1539 ATWOOD AVE STE 301
JOHNSTON RI
02919-3262
US

IV. Provider business mailing address

161 HOT AND COLD LN
SOMERSET MA
02726-2425
US

V. Phone/Fax

Practice location:
  • Phone: 401-490-4515
  • Fax: 401-490-4516
Mailing address:
  • Phone: 508-558-6419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: