Provider Demographics
NPI:1063306082
Name:HILLS, LETISHA SIMONE (LPN)
Entity type:Individual
Prefix:
First Name:LETISHA
Middle Name:SIMONE
Last Name:HILLS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:LETISHA
Other - Middle Name:SIMONE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:3896 VERTEX PATH APT 5
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13209-5055
Mailing Address - Country:US
Mailing Address - Phone:315-481-3043
Mailing Address - Fax:
Practice Address - Street 1:3896 VERTEX PATH APT 5
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13209-5055
Practice Address - Country:US
Practice Address - Phone:315-481-3043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309444251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care