Healthcare Provider Details

I. General information

NPI: 1265048805
Provider Name (Legal Business Name): HILLARY ANN BASHAW APNP FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS HILLARY ANN GRODDY

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 E ENTERPRISE AVE
APPLETON WI
54913-7862
US

IV. Provider business mailing address

3851 BOWER CREEK RD
DE PERE WI
54115-9220
US

V. Phone/Fax

Practice location:
  • Phone: 920-333-8878
  • Fax:
Mailing address:
  • Phone: 920-905-1801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10343-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: