Basic Information
Provider Information
NPI: 1003804030
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HILL
FirstName: CRYSTAL
MiddleName: DAWN
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7780 BRIER CREEK PKWY
Address2: STE 200
City: RALEIGH
State: NC
PostalCode: 276177869
CountryCode: US
TelephoneNumber: 9108156114
FaxNumber: 9102518824
Practice Location
Address1: 2421 SILVER STREAM LN
Address2:  
City: WILMINGTON
State: NC
PostalCode: 284017684
CountryCode: US
TelephoneNumber: 9103413300
FaxNumber: 9102518824
Other Information
ProviderEnumerationDate: 10/13/2005
LastUpdateDate: 04/03/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AS0400X104188NCY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical

ID Information
IDTypeStateIssuerDescription
10418801NCNC LICENSEOTHER
E098501NCMEDCOSTOTHER


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