Basic Information
| Provider Information | |||||||||
| NPI: | 1649452962 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HILDENBRAND | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | P.N.P. | ||||||||
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| OtherLastName: | HIPSAG | ||||||||
| OtherFirstName: | DEBRA | ||||||||
| OtherMiddleName: | ANN | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 8170 33RD AVE S # MS 21110Q | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554254516 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 LAKE DR E | ||||||||
| Address2: | |||||||||
| City: | CHANHASSEN | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553179302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529934300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2007 | ||||||||
| LastUpdateDate: | 03/10/2021 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 3610 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LP0200X | R 126301-1 | MN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.