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General NPI Number Information
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NPI Number | 1285107110
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Entity Type | Individual
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Provider Name | AUTUMN LEE HILLEGAS FNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/03/2019
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Last Update Date | 07/02/2019
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Provider Practice Location Address
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Address Line | 873 ROBERTSON BLVD
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City | WALTERBORO
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State | SC
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Zip | 29488-3082
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Country | US
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Telephone | 843-542-9535
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Fax |
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Provider Business Mailing Address
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Address Line | 5060 THORNTON DR
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City | SUMMERVILLE
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State | SC
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Zip | 29485-8894
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Country | US
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Telephone | 570-579-3511
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 22229
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License Number State | SC
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