Provider Demographics
NPI:1174949416
Name:HILDERBRAND, SUSAN (RN)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:HILDERBRAND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 W WESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-1868
Mailing Address - Country:US
Mailing Address - Phone:435-896-5451
Mailing Address - Fax:435-896-4353
Practice Address - Street 1:70 W WESTVIEW DR
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-1868
Practice Address - Country:US
Practice Address - Phone:435-896-5451
Practice Address - Fax:435-896-4353
Is Sole Proprietor?:No
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3291663102163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT998877683003Medicaid