Provider Demographics
NPI:1679984447
Name:HILL, TINA C
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:C
Last Name:HILL
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 1:402 E HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:LA FARGE
Mailing Address - State:WI
Mailing Address - Zip Code:54639-8647
Mailing Address - Country:US
Mailing Address - Phone:608-606-9321
Mailing Address - Fax:
Practice Address - Street 1:402 E HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:LA FARGE
Practice Address - State:WI
Practice Address - Zip Code:54639-8647
Practice Address - Country:US
Practice Address - Phone:608-606-9321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIH4008036064907344600000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No344600000XTransportation ServicesTaxi