Provider Demographics
NPI:1053806083
Name:AHOLA-JACQUES, HILLARY MARIE (PA-C, MPAS)
Entity type:Individual
Prefix:
First Name:HILLARY
Middle Name:MARIE
Last Name:AHOLA-JACQUES
Suffix:
Gender:F
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:HILLARY
Other - Middle Name:MARIE
Other - Last Name:AHOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:
Practice Address - Street 1:3935 N LIGHTNING DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913
Practice Address - Country:US
Practice Address - Phone:920-968-1790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4423-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant