Provider Demographics
NPI:1992959324
Name:HILLSTROM, JANEL IRENE (FNP, PMHNP)
Entity type:Individual
Prefix:MRS
First Name:JANEL
Middle Name:IRENE
Last Name:HILLSTROM
Suffix:
Gender:F
Credentials:FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 BERTHA HOWE AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:NV
Mailing Address - Zip Code:89027-7503
Mailing Address - Country:US
Mailing Address - Phone:702-346-0800
Mailing Address - Fax:702-346-0801
Practice Address - Street 1:1301 BERTHA HOWE AVE STE 8
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-7503
Practice Address - Country:US
Practice Address - Phone:702-346-0800
Practice Address - Fax:702-346-0801
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10503825-4405363LP0808X
NVAPRN001599363LP0808X
NVRN75911363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1992959324Medicaid