Provider Demographics
NPI:1366771834
Name:HILDRETH, MARILYN THERESE (RN, IBCLC, ICCE, CD)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:THERESE
Last Name:HILDRETH
Suffix:
Gender:F
Credentials:RN, IBCLC, ICCE, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4026 WILLOW LN
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-7016
Mailing Address - Country:US
Mailing Address - Phone:605-691-5808
Mailing Address - Fax:
Practice Address - Street 1:4026 WILLOW LN
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-7016
Practice Address - Country:US
Practice Address - Phone:605-691-5808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-13
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD108-56381163WL0100X
SD18011174H00000X
SD03936374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No174H00000XOther Service ProvidersHealth Educator
No374J00000XNursing Service Related ProvidersDoula