Organization Name: | NICK HILDRETH MEMORIAL CLINIC, LLC |
NPI Number: | 1689041329 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KYLIE JANE HILDRETH (ARNP/OWNER) |
Mailing Address: | 401 Court St Rockwell City |
State: | IA US |
Postal Code: | 505791534 |
Phone Number: | 5152373974 |
Fax Number: | 5152880122 |
NPI Enumeration Date: | 08/28/2015 |
NPI Last Update Date: | 09/14/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |