Provider Demographics
NPI:1467819045
Name:HILDEBRAND, JODI (NP)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:HILDEBRAND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 W 66TH ST STE 290
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2133
Mailing Address - Country:US
Mailing Address - Phone:952-914-1733
Mailing Address - Fax:
Practice Address - Street 1:3400 W 66TH ST STE 290
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2133
Practice Address - Country:US
Practice Address - Phone:952-914-1733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-183363-2363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care