Provider Demographics
NPI:1427102052
Name:HILDEBRANDT, CARRIE RUTH (RXN,NP)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:RUTH
Last Name:HILDEBRANDT
Suffix:
Gender:F
Credentials:RXN,NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12053 W 56TH CIR
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-1422
Mailing Address - Country:US
Mailing Address - Phone:303-423-7091
Mailing Address - Fax:
Practice Address - Street 1:1707 COLE BLVD
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-3220
Practice Address - Country:US
Practice Address - Phone:303-233-8295
Practice Address - Fax:303-716-8056
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO73505363LA2200X, 363LG0600X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO18301584Medicaid
COCO3000650Medicare PIN