Provider Demographics
NPI:1053664797
Name:HILDEBRAND, EMILY FOULKES (LAC, MSTOM)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:FOULKES
Last Name:HILDEBRAND
Suffix:
Gender:F
Credentials:LAC, MSTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-1250
Mailing Address - Country:US
Mailing Address - Phone:617-513-2766
Mailing Address - Fax:
Practice Address - Street 1:86 HENRY ST
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-1250
Practice Address - Country:US
Practice Address - Phone:617-513-2766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA261738171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist