Provider Demographics
NPI:1992582068
Name:HILL, JENNIFER (ADMINISTRATOR/LPN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HILL
Suffix:
Gender:F
Credentials:ADMINISTRATOR/LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9805 STATESVILLE RD STE 6128
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-7647
Mailing Address - Country:US
Mailing Address - Phone:980-433-0307
Mailing Address - Fax:
Practice Address - Street 1:5303 PEACHWOOD DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-1839
Practice Address - Country:US
Practice Address - Phone:980-433-0307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372500000X, 372600000X, 171M00000X
NC068996164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No171M00000XOther Service ProvidersCase Manager/Care Coordinator