Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 2016013734 | WI |
NPI | 1003363870 |
---|---|
Provider Name | Mrs. Jennifer Hidalgo Hruz |
First Address | Waukesha, WI 53186-6462 |
Second Address | New Berlin, WI 53151-2935 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2016 |
Last Update Date | 29/09/2016 |