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NPI Code Detail

MEDICARE: JONATHAN HILLIARD LPN

MEDICARE: JONATHAN HILLIARD LPN
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
1164W00000XLicensed Practical Nurse043115141IL
2164W00000XLicensed Practical Nurse27071194AIN

General Provider Information

NPI Number : 1841650454
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN HILLIARD LPN
Provider Business Mailing Address
First Line : 5517 N KENMORE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60640-1515
Country : US
Telephone Number : 773-275-7962
Fax Number :
Provider Business Practice Location Address
First Line : 5517 N KENMORE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60640-1515
Country : US
Telephone Number : 773-275-7962
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/25/2016
Last Update Date : 02/25/2016

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