Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 08110005 | MS |
NPI | 1164758652 |
---|---|
Provider Name | Renata Holland Hillman |
First Address | Lucedale, MS 39452-8820 |
Second Address | Lucedale, MS 39452-8820 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2009 |
Last Update Date | 19/10/2009 |