Healthcare Provider Details

I. General information

NPI: 1124214184
Provider Name (Legal Business Name): TRACY MARIE HILGERT RN,BSN,RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2007
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2052 ALEXANDRIA ROW
O FALLON MO
63368-8558
US

IV. Provider business mailing address

2052 ALEXANDRIA ROW
O FALLON MO
63368-8558
US

V. Phone/Fax

Practice location:
  • Phone: 618-225-7689
  • Fax: 618-466-4668
Mailing address:
  • Phone: 618-225-7689
  • Fax: 618-466-4668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number119634
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: