Basic Information
Provider Information
NPI: 1699248336
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HILBORN
FirstName: CATHERINE
MiddleName: A
NamePrefix: MISS
NameSuffix:  
Credential: CPNP-PC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 60447
Address2:  
City: CHARLOTTE
State: NC
PostalCode: 282600447
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 14215 BALLANTYNE CORPORATE PL STE 130
Address2:  
City: CHARLOTTE
State: NC
PostalCode: 28277
CountryCode: US
TelephoneNumber: 7043841950
FaxNumber: 7043841955
Other Information
ProviderEnumerationDate: 01/04/2019
LastUpdateDate: 10/26/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/25/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X5011291NCY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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