Provider Demographics
NPI:1619981115
Name:HILLSTRAND, MARY M (DNP, ANP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:HILLSTRAND
Suffix:
Gender:F
Credentials:DNP, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 PROVIDENCE DR
Mailing Address - Street 2:SUITE A-466
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4627
Mailing Address - Country:US
Mailing Address - Phone:907-263-2200
Mailing Address - Fax:907-276-0366
Practice Address - Street 1:3340 PROVIDENCE DR
Practice Address - Street 2:SUITE A-466
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4627
Practice Address - Country:US
Practice Address - Phone:907-263-2200
Practice Address - Fax:907-276-0366
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAK540363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1022642Medicaid
AKK162913Medicare PIN
AKNP15405Medicaid