Provider Demographics
NPI:1093846578
Name:HILGENBERG, JENNIFER HALTERMAN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:HALTERMAN
Last Name:HILGENBERG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 COMPUTER DR STE 301
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-1790
Mailing Address - Country:US
Mailing Address - Phone:617-420-5316
Mailing Address - Fax:
Practice Address - Street 1:1400 COMPUTER DR STE 301
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-1790
Practice Address - Country:US
Practice Address - Phone:617-420-5316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00390363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant