Provider Demographics
NPI:1508868118
Name:HILL, ROBERT JON (CRNA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JON
Last Name:HILL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 9TH ST N
Mailing Address - Street 2:ESSENTIA HEALTH VIRGINIA
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792-2325
Mailing Address - Country:US
Mailing Address - Phone:218-741-3340
Mailing Address - Fax:
Practice Address - Street 1:901 9TH ST N
Practice Address - Street 2:ESSENTIA HEALTH VIRGINIA
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-2325
Practice Address - Country:US
Practice Address - Phone:218-741-3340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR128230-6367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1508868118Medicaid
MN034938100Medicaid
MN430008043Medicare PIN
MN430004589Medicare ID - Type Unspecified