Healthcare Provider Details

I. General information

NPI: 1851345524
Provider Name (Legal Business Name): TERESA A HILDEBRAND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 SE TECH CENTER DRIVE SUITE 120
VANCOUVER WA
98683
US

IV. Provider business mailing address

1000 SE TECH CENTER DRIVE SUITE 120
VANCOUVER WA
98683
US

V. Phone/Fax

Practice location:
  • Phone: 360-260-2773
  • Fax: 360-260-2217
Mailing address:
  • Phone: 360-260-2773
  • Fax: 360-260-2217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00031170
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: