Provider Demographics
NPI:1508857111
Name:HILSENRAD, MAUREEN ELIZABETH (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:ELIZABETH
Last Name:HILSENRAD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 43905
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40253-0905
Mailing Address - Country:US
Mailing Address - Phone:502-538-4700
Mailing Address - Fax:502-583-8434
Practice Address - Street 1:1170 E BROADWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1744
Practice Address - Country:US
Practice Address - Phone:502-583-4700
Practice Address - Fax:502-583-8434
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3246P363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00350411OtherMEDICARE RAILROAD
KY000000333453OtherANTHEM BLUE CROSS BLUE SH
KY000000333453OtherANTHEM BLUE CROSS BLUE SH
KYP00350411OtherMEDICARE RAILROAD
KYK115300Medicare PIN