Basic Information
| Provider Information | |||||||||
| NPI: | 1124002563 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HILL | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | CARROLL | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 912 32ND ST | ||||||||
| Address2: | |||||||||
| City: | ANACORTES | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982213473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602934343 | ||||||||
| FaxNumber: | 3605881587 | ||||||||
| Practice Location | |||||||||
| Address1: | 2116 E SECTION ST | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982749124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604281700 | ||||||||
| FaxNumber: | 3608484350 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2005 | ||||||||
| LastUpdateDate: | 08/30/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 025804 AP30000064 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | AP30000064 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 532300002 | 01 | GROUP HEALTH | OTHER | 8937842 | 01 | CRIME VICTIMS | OTHER | 912109329 | 01 | PREMERA BLUE CROSS | OTHER | 912109329 | 01 | TRIWEST | OTHER | 912109329 | 01 | TAX ID | OTHER | 5403262 | 01 | CCN | OTHER | 5782HI | 01 | REGENCE BLUE SHIELD | OTHER | 912109329 | 01 | UNIFORM | OTHER | 912109329 | 01 | FIRST CHOICE | OTHER | 0152515 | 01 | LABOR AND INDUSTRIES | OTHER | 912109329 | 01 | CIGNA BEECH ST | OTHER | 9630278 | 01 | DSHS | OTHER | 98250A002 | 01 | TRIWEST | OTHER |