Provider Demographics
NPI:1437452463
Name:HILDEBRAND, KATHY ANN (CIHC)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:ANN
Last Name:HILDEBRAND
Suffix:
Gender:F
Credentials:CIHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7336 SHERATON DR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112-3679
Mailing Address - Country:US
Mailing Address - Phone:703-725-6939
Mailing Address - Fax:703-791-2204
Practice Address - Street 1:7336 SHERATON DR
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20112-3679
Practice Address - Country:US
Practice Address - Phone:703-725-6939
Practice Address - Fax:703-791-2204
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A133N00000X, 133NN1002X, 174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA58093011OtherAADP