1790715886 NPI number — LORRAINE LEILANI HILL FNP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790715886 NPI number — LORRAINE LEILANI HILL FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HILL
Provider First Name:
LORRAINE
Provider Middle Name:
LEILANI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HILL
Provider Other First Name:
LORRAINE
Provider Other Middle Name:
LEILANI
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1790715886
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 BAWDEN ST
Provider Second Line Business Mailing Address:
SUITE 313
Provider Business Mailing Address City Name:
KETCHIKAN
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99901-6573
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-220-9982
Provider Business Mailing Address Fax Number:
907-220-9972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 BAWDEN ST
Provider Second Line Business Practice Location Address:
SUITE 313
Provider Business Practice Location Address City Name:
KETCHIKAN
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99901-6573
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-220-9982
Provider Business Practice Location Address Fax Number:
907-220-9972
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  18345 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CL2696 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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