Provider Demographics
NPI:1740326933
Name:CZAJA, JILL R (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:R
Last Name:CZAJA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7968 HWY 19E
Mailing Address - Street 2:BRMC-MAYLAND CAMPUS
Mailing Address - City:SPRUCE PINE
Mailing Address - State:NC
Mailing Address - Zip Code:28777-6011
Mailing Address - Country:US
Mailing Address - Phone:828-765-4111
Mailing Address - Fax:828-765-5676
Practice Address - Street 1:7968 HWY 19E
Practice Address - Street 2:BRMC-MAYLAND CAMPUS
Practice Address - City:SPRUCE PINE
Practice Address - State:NC
Practice Address - Zip Code:28777-6011
Practice Address - Country:US
Practice Address - Phone:828-765-4111
Practice Address - Fax:828-765-5676
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103615363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8103074Medicaid
NCP97662Medicare UPIN