Provider Demographics
NPI:1033938691
Name:THILL, AKEYLA DAWN (LPN)
Entity type:Individual
Prefix:
First Name:AKEYLA
Middle Name:DAWN
Last Name:THILL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 CROWN POINT RD
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-5794
Mailing Address - Country:US
Mailing Address - Phone:360-560-3043
Mailing Address - Fax:
Practice Address - Street 1:66 CROWN POINT RD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-5794
Practice Address - Country:US
Practice Address - Phone:360-560-3043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10023915164W00000X
WALP61508631164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse