Provider Demographics
NPI:1861956724
Name:HILLIARD, THESALONICA PAIGE (NP)
Entity type:Individual
Prefix:MS
First Name:THESALONICA
Middle Name:PAIGE
Last Name:HILLIARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:THESALONICA
Other - Middle Name:PAIGE
Other - Last Name:HILLIARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:1815 ELDORA ST
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-3705
Mailing Address - Country:US
Mailing Address - Phone:619-621-4771
Mailing Address - Fax:
Practice Address - Street 1:1815 ELDORA ST
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-3705
Practice Address - Country:US
Practice Address - Phone:619-621-4771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95010585363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty