Basic Information
| Provider Information | |||||||||
| NPI: | 1992959324 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HILLSTROM | ||||||||
| FirstName: | JANEL | ||||||||
| MiddleName: | IRENE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | FNP, PMHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 BERTHA HOWE AVE STE 8 | ||||||||
| Address2: | |||||||||
| City: | MESQUITE | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890277503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023460800 | ||||||||
| FaxNumber: | 7023460801 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 BERTHA HOWE AVE STE 8 | ||||||||
| Address2: | |||||||||
| City: | MESQUITE | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890277503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023460800 | ||||||||
| FaxNumber: | 7023460801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2008 | ||||||||
| LastUpdateDate: | 03/23/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 10503825-4405 | UT | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363LP0808X | APRN001599 | NV | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363L00000X | RN75911 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 1992959324 | 05 | NV | MEDICAID |