Healthcare Provider Details

I. General information

NPI: 1790130342
Provider Name (Legal Business Name): MEGAN HILGENBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 DR MARTIN LUTHER KING JR AVE NE
ALBUQUERQUE NM
87102
US

IV. Provider business mailing address

10300 GOLF COURSE RD NW APT 1211
ALBUQUERQUE NM
87114-3926
US

V. Phone/Fax

Practice location:
  • Phone: 801-494-7792
  • Fax:
Mailing address:
  • Phone: 801-494-7792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number218968-30
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041418473
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number57276
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: