Provider Demographics
NPI:1154082840
Name:HILBURN, MICHAEL DALE (FNP-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DALE
Last Name:HILBURN
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5440 S J DIAMOND RD
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86005-9329
Mailing Address - Country:US
Mailing Address - Phone:806-336-9061
Mailing Address - Fax:
Practice Address - Street 1:2000 S THOMPSON ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-8759
Practice Address - Country:US
Practice Address - Phone:928-226-6400
Practice Address - Fax:928-226-6410
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ268141363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily