Healthcare Provider Details

I. General information

NPI: 1235883497
Provider Name (Legal Business Name): JENNIFER REBECCA HILMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER REBECCA SHAW RN

II. Dates (important events)

Enumeration Date: 02/07/2022
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4003 CREEKSIDE LOOP
YAKIMA WA
98908-3962
US

IV. Provider business mailing address

420 WISE ACRE RD
YAKIMA WA
98901-9371
US

V. Phone/Fax

Practice location:
  • Phone: 509-249-5243
  • Fax: 509-575-5006
Mailing address:
  • Phone: 509-899-9968
  • Fax: 800-590-0961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number00119088
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: