1194762302 NPI number — MS. GEORGIANA CARUSO-HILL APRN, FNP

Table of content: MS. GEORGIANA CARUSO-HILL APRN, FNP (NPI 1194762302)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194762302 NPI number — MS. GEORGIANA CARUSO-HILL APRN, FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARUSO-HILL
Provider First Name:
GEORGIANA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN, FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194762302
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 88
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODLAND PARK
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80866-0088
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-695-1338
Provider Business Mailing Address Fax Number:
719-686-7583

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45825 HWY 96
Provider Second Line Business Practice Location Address:
BUILDING K100
Provider Business Practice Location Address City Name:
PUEBLO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-549-5491
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/31/2006

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: 163W00000X , with the licence number:  115122 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 115122 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 4055 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 57434034 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".