=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427602705
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA HILLIARD PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2019
-----------------------------------------------------
Last Update Date | 11/06/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1539 ATWOOD AVE STE 301
-----------------------------------------------------
City | JOHNSTON
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02919-3262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-490-4515
-----------------------------------------------------
Fax | 401-490-4516
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 161 HOT AND COLD LN
-----------------------------------------------------
City | SOMERSET
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02726-2425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-558-6419
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------