Provider Demographics
NPI:1598918088
Name:ADRIAN, HILLARY KRUEGER (PAC)
Entity Type:Individual
Prefix:
First Name:HILLARY
Middle Name:KRUEGER
Last Name:ADRIAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:HILLARY
Other - Middle Name:KATHRYN
Other - Last Name:KRUEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:450 S KITSAP BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-3709
Mailing Address - Country:US
Mailing Address - Phone:360-744-6275
Mailing Address - Fax:360-744-6270
Practice Address - Street 1:450 S KITSAP BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3709
Practice Address - Country:US
Practice Address - Phone:360-744-6275
Practice Address - Fax:360-744-6270
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4660363AM0700X
WAPA60048381363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ549709Medicaid
WA0289408OtherSTATE L&I
WA2000370Medicaid
WA0302313OtherSTATE L&I
WA0289416OtherSTATE L&I
WA0289410OtherSTATE L&I
WA0289411OtherSTATE L&I
WA0289414OtherSTATE L&I
WA0289414OtherSTATE L&I
WAG8886516Medicare PIN
WAG8914145Medicare PIN
WA0302313OtherSTATE L&I