Provider Demographics
NPI:1821099060
Name:HILL, JERRY RUSSELL (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:RUSSELL
Last Name:HILL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:24559 S KLINGVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CHASSELL
Mailing Address - State:MI
Mailing Address - Zip Code:49916-9265
Mailing Address - Country:US
Mailing Address - Phone:906-523-6129
Mailing Address - Fax:906-523-6129
Practice Address - Street 1:205 OSCEOLA ST
Practice Address - Street 2:
Practice Address - City:LAURIUM
Practice Address - State:MI
Practice Address - Zip Code:49913-2134
Practice Address - Country:US
Practice Address - Phone:906-337-6500
Practice Address - Fax:906-523-6129
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERNA203021367500000X
MI4704093472367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MERNA203021OtherCRNA LICENSE
MI4704093472OtherMICHIGAN LICENSE
MERN76197OtherRN LICENSE