Provider Demographics
NPI:1326344292
Name:EHLERS, HILDEGARD RUTH
Entity Type:Individual
Prefix:MS
First Name:HILDEGARD
Middle Name:RUTH
Last Name:EHLERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 UTOPIAN DR E
Mailing Address - Street 2:APART. 207
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-4259
Mailing Address - Country:US
Mailing Address - Phone:727-723-2398
Mailing Address - Fax:
Practice Address - Street 1:2209 UTOPIAN DR E
Practice Address - Street 2:APART. 207
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-4259
Practice Address - Country:US
Practice Address - Phone:727-723-2398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL688046102374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL688046101OtherMEDICAID WAIVER
FL688046102Medicaid