Provider Demographics
NPI:1861536427
Name:HILZENDEGER, JEFF (PA-C)
Entity type:Individual
Prefix:MR
First Name:JEFF
Middle Name:
Last Name:HILZENDEGER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1397
Mailing Address - Street 2:SUITE 401
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58502-1397
Mailing Address - Country:US
Mailing Address - Phone:701-223-1967
Mailing Address - Fax:701-223-6597
Practice Address - Street 1:810 E ROSSER AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4463
Practice Address - Country:US
Practice Address - Phone:701-223-1967
Practice Address - Fax:701-223-6597
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0432363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant