Healthcare Provider Details

I. General information

NPI: 1366676546
Provider Name (Legal Business Name): STEPHANIE NICOLE HILL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2009
Last Update Date: 08/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 VARNUM ST NE STE 117
WASHINGTON DC
20017-2107
US

IV. Provider business mailing address

1160 VARNUM ST NE STE 117
WASHINGTON DC
20017-2107
US

V. Phone/Fax

Practice location:
  • Phone: 202-832-7007
  • Fax:
Mailing address:
  • Phone: 202-832-7007
  • Fax: 757-594-2195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110003003
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: