Healthcare Provider Details

I. General information

NPI: 1053403766
Provider Name (Legal Business Name): HILLARY LEE HINKSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HILLARY NYSTROM PA-C

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10610 N PORT WASHINGTON RD
MEQUON WI
53092-5013
US

IV. Provider business mailing address

10001 W INNOVATION DR STE 200
MILWAUKEE WI
53226-4851
US

V. Phone/Fax

Practice location:
  • Phone: 888-938-3838
  • Fax:
Mailing address:
  • Phone: 888-938-3838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2374-23
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: