Provider Demographics
NPI:1255501987
Name:HILGENBERG, ANDREA J (NP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:J
Last Name:HILGENBERG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2575 E EVERGREEN DRIVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-2883
Mailing Address - Country:US
Mailing Address - Phone:920-969-5353
Mailing Address - Fax:414-337-7201
Practice Address - Street 1:2575 E EVERGREEN DRIVE
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-2883
Practice Address - Country:US
Practice Address - Phone:920-969-5353
Practice Address - Fax:414-337-7201
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3370-033363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1255501987Medicaid