Provider Demographics
NPI:1326392978
Name:HILL, WHITNEY NICOLE (PA-C, MSBS)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:NICOLE
Last Name:HILL
Suffix:
Gender:F
Credentials:PA-C, MSBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15300 WEST AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4686
Mailing Address - Country:US
Mailing Address - Phone:708-226-2870
Mailing Address - Fax:708-226-2390
Practice Address - Street 1:15300 WEST AVE STE 210
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4686
Practice Address - Country:US
Practice Address - Phone:708-226-2870
Practice Address - Fax:708-226-2390
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085010748363A00000X
WI3388-23363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1326392978Medicaid