Healthcare Provider Details

I. General information

NPI: 1942571187
Provider Name (Legal Business Name): CAROLE HILDEBRANDT NUTRITIONIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16245 SW 93RD AVE
PORTLAND OR
97224-5588
US

IV. Provider business mailing address

16245 SW 93RD AVE
PORTLAND OR
97224-5588
US

V. Phone/Fax

Practice location:
  • Phone: 971-275-6823
  • Fax:
Mailing address:
  • Phone: 971-275-6823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number000984
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: