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General NPI Number Information
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NPI Number | 1073167094
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Entity Type | Individual
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Provider Name | CARLY HILLEBRANDT FNP
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Gender | Female
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Dates
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Enumeration Date | 07/29/2019
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Last Update Date | 07/29/2019
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Provider Practice Location Address
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Address Line | 3649 S BEGLIS PKWY
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City | SULPHUR
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State | LA
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Zip | 70665-8107
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Country | US
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Telephone | 337-626-1011
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Fax | 337-558-5585
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Provider Business Mailing Address
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Address Line | 7217 E SAVANNAH LN
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City | LAKE CHARLES
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State | LA
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Zip | 70605-8164
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Country | US
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Telephone | 337-224-7789
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 207256
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License Number State | LA
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