MEDICARE: CRYSTAL A HILLIARD LVN

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	164W00000X	Licensed Practical Nurse	342760	TX

General Provider Information

NPI Number	:	1558997932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL A HILLIARD LVN

Provider Business Mailing Address
First Line	:	2241 S STATE HIGHWAY 121 APT 636
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-3760
Country	:	US
Telephone Number	:	318-317-6729
Fax Number	:

Provider Business Practice Location Address
First Line	:	2241 S STATE HIGHWAY 121 APT 636
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-3760
Country	:	US
Telephone Number	:	318-317-6729
Fax Number	:

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

Provider Enumeration Date	:	03/18/2020
Last Update Date	:	03/18/2020

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