Provider Demographics
NPI:1841961315
Name:HILL, CRUSSANA RENEE
Entity type:Individual
Prefix:
First Name:CRUSSANA
Middle Name:RENEE
Last Name:HILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6615 KENTSTONE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-4852
Mailing Address - Country:US
Mailing Address - Phone:317-629-2235
Mailing Address - Fax:
Practice Address - Street 1:6615 KENTSTONE DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-4852
Practice Address - Country:US
Practice Address - Phone:317-629-2235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2021-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN21-015314-1376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN86-1822727OtherPRIVATE PAY