Basic Information
| Provider Information | |||||||||
| NPI: | 1265577746 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HILLESHEIM | ||||||||
| FirstName: | NADINE | ||||||||
| MiddleName: | ANN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4033 39TH ST S | ||||||||
| Address2: | |||||||||
| City: | MOORHEAD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 565606942 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1201 25TH ST S | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581032311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7014514900 | ||||||||
| FaxNumber: | 7014515057 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 464-8-15-01-29 | ND | X | Behavioral Health & Social Service Providers | Counselor | Professional | 103T00000X | 0777 | MN | X | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 2078682 | 01 | ND | CIGNA | OTHER | 21678 | 01 | ND | BCBSND | OTHER | 58103-A006 | 01 | ND | TRIWEST | OTHER | HP35520 | 01 | ND | HEALTH PARTNERS | OTHER | 8L049KL | 01 | MN | BCBSMN | OTHER | 3100200501 | 01 | ND | PRIMEWEST | OTHER | 2352435 | 01 | ND | AMERICA'S PPO | OTHER | 62-06074 | 01 | ND | MEDICA UBH | OTHER |