Provider Demographics
NPI:1679701999
Name:MULHOLLAND, HILERY DIANE MOORE
Entity type:Individual
Prefix:
First Name:HILERY
Middle Name:DIANE MOORE
Last Name:MULHOLLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5828 MINNOW DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-7560
Mailing Address - Country:US
Mailing Address - Phone:602-616-9196
Mailing Address - Fax:
Practice Address - Street 1:5828 MINNOW DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-7560
Practice Address - Country:US
Practice Address - Phone:602-616-9196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN131410163W00000X
CO163125163W00000X
CA841282163W00000X
TX727626163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No163W00000XNursing Service ProvidersRegistered Nurse