Provider Demographics
NPI:1972904472
Name:HILLS, PAMELA ANN (TEACHING)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANN
Last Name:HILLS
Suffix:
Gender:F
Credentials:TEACHING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 232
Mailing Address - Street 2:403 SOUTH NICHOLS STREET
Mailing Address - City:NICHOLS
Mailing Address - State:SC
Mailing Address - Zip Code:29581-0232
Mailing Address - Country:US
Mailing Address - Phone:860-818-2595
Mailing Address - Fax:
Practice Address - Street 1:403 SOUTH NICHOLS STREET
Practice Address - Street 2:
Practice Address - City:NICHOLS
Practice Address - State:SC
Practice Address - Zip Code:29581-0232
Practice Address - Country:US
Practice Address - Phone:860-818-2595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC122009000619171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC122009000691OtherCONNECTICUT STATE DEPARTMENT OF EDUCATION