Basic Information
| Provider Information | |||||||||
| NPI: | 1740326933 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CZAJA | ||||||||
| FirstName: | JILL | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7968 HWY 19E | ||||||||
| Address2: | BRMC-MAYLAND CAMPUS | ||||||||
| City: | SPRUCE PINE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287776011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287654111 | ||||||||
| FaxNumber: | 8287655676 | ||||||||
| Practice Location | |||||||||
| Address1: | 7968 HWY 19E | ||||||||
| Address2: | BRMC-MAYLAND CAMPUS | ||||||||
| City: | SPRUCE PINE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287776011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287654111 | ||||||||
| FaxNumber: | 8287655676 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 08/07/2013 | ||||||||
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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 | 363A00000X | 103615 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 8103074 | 05 | NC | MEDICAID |