Provider Demographics
NPI:1124002563
Name:HILL, SUSAN CARROLL (ARNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:CARROLL
Last Name:HILL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 32ND ST
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-3473
Mailing Address - Country:US
Mailing Address - Phone:360-293-4343
Mailing Address - Fax:360-588-1587
Practice Address - Street 1:2116 E SECTION ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-9124
Practice Address - Country:US
Practice Address - Phone:360-428-1700
Practice Address - Fax:360-848-4350
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA025804 AP30000064363LF0000X
WAAP30000064363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
532300002OtherGROUP HEALTH
8937842OtherCRIME VICTIMS
912109329OtherPREMERA BLUE CROSS
912109329OtherTRIWEST
912109329OtherTAX ID
5403262OtherCCN
5782HIOtherREGENCE BLUE SHIELD
912109329OtherUNIFORM
912109329OtherFIRST CHOICE
0152515OtherLABOR AND INDUSTRIES
912109329OtherCIGNA BEECH ST
9630278OtherDSHS
98250A002OtherTRIWEST
912109329OtherFIRST CHOICE
AB23282Medicare ID - Type Unspecified