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NPI Code Detail

MEDICARE: MS. KELLY CLARK HILDENBRAND BSN, RN

MEDICARE: MS. KELLY CLARK HILDENBRAND BSN, RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseOSBN 09600231RNOR

General Provider Information

NPI Number : 1144419599
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KELLY CLARK HILDENBRAND BSN, RN
Provider Business Mailing Address
First Line : 3925 SE 48TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97206-3231
Country : US
Telephone Number : 503-771-5602
Fax Number :
Provider Business Practice Location Address
First Line : 3925 SE 48TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97206-3231
Country : US
Telephone Number : 503-771-5602
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/22/2007
Last Update Date : 10/22/2007

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