Provider Demographics
NPI:1699736231
Name:HILLIARD, LORIE O'CONNOR (CRNA)
Entity type:Individual
Prefix:
First Name:LORIE
Middle Name:O'CONNOR
Last Name:HILLIARD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LORIE
Other - Middle Name:O'CONNOR
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:68 S SERVICE RD
Mailing Address - Street 2:STE 350
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2354
Mailing Address - Country:US
Mailing Address - Phone:516-945-3107
Mailing Address - Fax:516-945-3131
Practice Address - Street 1:618 HOSPITAL RD
Practice Address - Street 2:DEPARTMENT OF ANESTHESIA
Practice Address - City:TAPPAHANNOCK
Practice Address - State:VA
Practice Address - Zip Code:22560-5000
Practice Address - Country:US
Practice Address - Phone:804-443-3311
Practice Address - Fax:703-295-9369
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024116011367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA181126816Medicaid
VA1699736231Medicaid
VAQ40618AMedicare PIN
VA1699736231Medicaid