Basic Information
| Provider Information | |||||||||
| NPI: | 1699717264 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HILDERBRAND | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | IATAN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 688 | ||||||||
| Address2: | |||||||||
| City: | INDEPENDENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 673010688 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6203311748 | ||||||||
| FaxNumber: | 6203321940 | ||||||||
| Practice Location | |||||||||
| Address1: | 3751 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | INDEPENDENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 673018446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6203311748 | ||||||||
| FaxNumber: | 6203321940 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 1354096072 | KS | Y | Nursing Service Providers | Registered Nurse |
No ID Information.