Provider Demographics
NPI:1841801636
Name:HILL, SHEILA RENEE
Entity type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:RENEE
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 1:1931 CEDAR RIDGE DR APT 23
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-4635
Mailing Address - Country:US
Mailing Address - Phone:707-654-5075
Mailing Address - Fax:
Practice Address - Street 1:1931 CEDAR RIDGE DR APT 23
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-4635
Practice Address - Country:US
Practice Address - Phone:707-654-5075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAN7519127172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver