Individual
MRS. JILL MARIE HIETPAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA C
Contact information
Practice address
1835 E EDGEWOOD DR STE 10535, APPLETON, WI 54913-9407
(920) 215-0102
(920) 214-0795
Mailing address
N2611 HUSS CT, FREEDOM, WI 54130-8674
(920) 915-2669
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1285023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32494700
—
WI
Enumeration date
05/12/2006
Last updated
10/26/2023
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