Healthcare Provider Details

I. General information

NPI: 1649452962
Provider Name (Legal Business Name): DEBRA ANN HILDENBRAND P.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBRA ANN HIPSAG

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LAKE DR E
CHANHASSEN MN
55317-9302
US

IV. Provider business mailing address

8170 33RD AVE S # MS 21110Q
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-4300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3610
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR 126301-1
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: