Provider Demographics
NPI:1669410189
Name:HILLARD, ADAM (CRNA)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:HILLARD
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 S WADSWORTH BLVD
Mailing Address - Street 2:STE. D-100
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-5122
Mailing Address - Country:US
Mailing Address - Phone:303-205-1090
Mailing Address - Fax:
Practice Address - Street 1:7000 W COLFAX AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-5433
Practice Address - Country:US
Practice Address - Phone:303-996-1188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC235382163W00000X, 367500000X
VA0024166963367500000X
VA0001200777163W00000X
COAPN.0004199367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO74302884Medicaid
VA001247A26Medicare UPIN
CO74302884Medicaid
COCOAAA1148Medicare PIN
VA001247A26Medicare Oscar/Certification