Provider Demographics
NPI:1265048805
Name:BASHAW, HILLARY ANN (APNP FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:HILLARY
Middle Name:ANN
Last Name:BASHAW
Suffix:
Gender:F
Credentials:APNP FNP-BC
Other - Prefix:MISS
Other - First Name:HILLARY
Other - Middle Name:ANN
Other - Last Name:GRODDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3851 BOWER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-9220
Mailing Address - Country:US
Mailing Address - Phone:920-905-1801
Mailing Address - Fax:
Practice Address - Street 1:1726 SHAWANO AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-3216
Practice Address - Country:US
Practice Address - Phone:920-498-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10343-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner