Basic Information
Provider Information
NPI: 1255716817
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HILL
FirstName: ALLISON
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1401 E 1ST ST
Address2:  
City: DULUTH
State: MN
PostalCode: 558052407
CountryCode: US
TelephoneNumber: 2187284491
FaxNumber: 2187284404
Practice Location
Address1: 310 S 2ND AVE
Address2:  
City: VIRGINIA
State: MN
PostalCode: 557922616
CountryCode: US
TelephoneNumber: 2187502457
FaxNumber: 7122010340
Other Information
ProviderEnumerationDate: 07/24/2015
LastUpdateDate: 02/05/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/05/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0808XCNP 3970MNY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsych/Mental Health

No ID Information.


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