Healthcare Provider Details

I. General information

NPI: 1124006796
Provider Name (Legal Business Name): JAMES HILDEBRAND CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 5TH ST NE
JAMESTOWN ND
58401-3300
US

IV. Provider business mailing address

419 5TH ST NE
JAMESTOWN ND
58401-3300
US

V. Phone/Fax

Practice location:
  • Phone: 701-252-1050
  • Fax: 701-952-3265
Mailing address:
  • Phone: 701-252-1050
  • Fax: 701-952-3265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR15787
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: