MEDICARE: PATRICIA ANN HILL CNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	230454530299	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	230454530299	OTHER	MI	PROMETRIC

General Provider Information

NPI Number	:	1275869323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA ANN HILL CNA

Provider Business Mailing Address
First Line	:	318 VISSER ST
Second Line	:
City	:	SPRING LAKE
State	:	MI
Zip	:	49456-2063
Country	:	US
Telephone Number	:	616-607-8527
Fax Number	:

Provider Business Practice Location Address
First Line	:	318 VISSER ST
Second Line	:
City	:	SPRING LAKE
State	:	MI
Zip	:	49456-2063
Country	:	US
Telephone Number	:	616-607-8527
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2009
Last Update Date	:	10/26/2009

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