1104100825 NPI number — JILL ADAIR HARPER CRNA

Table of content: JILL ADAIR HARPER CRNA (NPI 1104100825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104100825 NPI number — JILL ADAIR HARPER CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARPER
Provider First Name:
JILL
Provider Middle Name:
ADAIR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HUNTER
Provider Other First Name:
JILL
Provider Other Middle Name:
ADAIR
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1104100825
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4504 STARKEY RD
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
ROANOKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24018-8535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-718-5389
Provider Business Mailing Address Fax Number:
336-718-9271

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
76 PEACHTREE RD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28803-3395
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-718-5389
Provider Business Practice Location Address Fax Number:
336-718-9271
Provider Enumeration Date:
09/29/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  0024173472 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)