Provider Demographics
NPI:1609154426
Name:HILLIS, VICKI LYNN (CPNP)
Entity type:Individual
Prefix:MS
First Name:VICKI
Middle Name:LYNN
Last Name:HILLIS
Suffix:
Gender:F
Credentials:CPNP
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Other - Last Name:
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Mailing Address - Street 1:30210 RANCHO VIEJO RD STE A
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1574
Mailing Address - Country:US
Mailing Address - Phone:949-493-1383
Mailing Address - Fax:949-493-1418
Practice Address - Street 1:30210 RANCHO VIEJO RD STE A
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1574
Practice Address - Country:US
Practice Address - Phone:949-493-1383
Practice Address - Fax:949-493-1418
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA307213363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics