MEDICARE: CRUSSANA RENEE HILL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376J00000X	Homemaker	21-015314-1	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	86-1822727	OTHER	IN	PRIVATE PAY

General Provider Information

NPI Number	:	1841961315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRUSSANA RENEE HILL

Provider Business Mailing Address
First Line	:	6615 KENTSTONE DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-4852
Country	:	US
Telephone Number	:	317-629-2235
Fax Number	:

Provider Business Practice Location Address
First Line	:	6615 KENTSTONE DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-4852
Country	:	US
Telephone Number	:	317-629-2235
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2021
Last Update Date	:	10/03/2021

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Directions to “ CRUSSANA RENEE HILL ” Practice Location

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