Provider Demographics
NPI:1932674298
Name:RISTINE, HILLARY E (NP)
Entity Type:Individual
Prefix:
First Name:HILLARY
Middle Name:E
Last Name:RISTINE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:HILLARY
Other - Middle Name:E
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1115 RONALD REAGAN PKWY STE 364
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-6914
Practice Address - Country:US
Practice Address - Phone:317-217-2700
Practice Address - Fax:317-217-2707
Is Sole Proprietor?:No
Enumeration Date:2018-10-12
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71008464A363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN064740035OtherMEDICARE
IN300021551Medicaid