Provider Demographics
NPI:1235696436
Name:HILLARD, LAURA (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:HILLARD
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:WOLFGANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:PO BOX 746723
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6723
Mailing Address - Country:US
Mailing Address - Phone:127-339-7303
Mailing Address - Fax:
Practice Address - Street 1:3022 S MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-2695
Practice Address - Country:US
Practice Address - Phone:517-253-1304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-23
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704253317363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily