Provider Demographics
NPI:1639132053
Name:HILL, MARIE ELAINE (FNP)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ELAINE
Last Name:HILL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:704-384-9103
Mailing Address - Fax:704-316-9633
Practice Address - Street 1:9550 ROCKY RIVER RD STE 150
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215
Practice Address - Country:US
Practice Address - Phone:704-316-5281
Practice Address - Fax:704-316-5283
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200587363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2593636Medicare ID - Type Unspecified
NCS86626Medicare UPIN