Provider Demographics
NPI:1487297271
Name:HILL, MACKENNA LESLIE (FNP-C)
Entity type:Individual
Prefix:
First Name:MACKENNA
Middle Name:LESLIE
Last Name:HILL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 MIDLANE DR
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60083-9459
Mailing Address - Country:US
Mailing Address - Phone:815-440-1032
Mailing Address - Fax:
Practice Address - Street 1:11002 W PARK PL
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-3615
Practice Address - Country:US
Practice Address - Phone:888-562-5442
Practice Address - Fax:844-861-1929
Is Sole Proprietor?:No
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209020227363LF0000X
WI970833363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily