Provider Demographics
NPI:1437604212
Name:BICKEL, HILLARY ANN (PA)
Entity Type:Individual
Prefix:
First Name:HILLARY
Middle Name:ANN
Last Name:BICKEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:HILLARY
Other - Middle Name:ANN
Other - Last Name:TAZELAAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:300 68TH ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49548-6927
Mailing Address - Country:US
Mailing Address - Phone:616-455-5000
Mailing Address - Fax:616-455-5960
Practice Address - Street 1:926 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-7725
Practice Address - Country:US
Practice Address - Phone:616-820-3780
Practice Address - Fax:616-455-5960
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
MI363A00000X
MI5601007910363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant