Provider Demographics
NPI:1992328371
Name:HILL, PAULA LYNN (RN, BSN, ACDES)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:LYNN
Last Name:HILL
Suffix:
Gender:F
Credentials:RN, BSN, ACDES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 WARWICK ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-2693
Mailing Address - Country:US
Mailing Address - Phone:269-443-3984
Mailing Address - Fax:
Practice Address - Street 1:1910 SHAFFER ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1604
Practice Address - Country:US
Practice Address - Phone:269-382-9820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704231330163WD0400X
MI4707231330163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator