Provider Demographics
NPI:1639254568
Name:HILL, GAYLE G (CRNA)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:G
Last Name:HILL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:NC
Mailing Address - Zip Code:28516-2230
Mailing Address - Country:US
Mailing Address - Phone:252-728-6906
Mailing Address - Fax:
Practice Address - Street 1:813 FRONT ST
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:NC
Practice Address - Zip Code:28516-2230
Practice Address - Country:US
Practice Address - Phone:252-728-6906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSRA-25012367500000X
FLAPRN3249762367500000X
SC583367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC048593OtherCRNA CERTIFICATION
CO05237874Medicaid
SCAN 1452Medicaid
SCQ340597226Medicare PIN
COCO307095Medicare PIN