Healthcare Provider Details

I. General information

NPI: 1336103753
Provider Name (Legal Business Name): KAREN JO HILDRETH APN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 W WASHINGTON ST
BLOOMINGTON IL
61701-3875
US

IV. Provider business mailing address

3633 N 2000 EAST RD
FAIRBURY IL
61739-9180
US

V. Phone/Fax

Practice location:
  • Phone: 309-827-4014
  • Fax:
Mailing address:
  • Phone: 815-692-3795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: