Provider Demographics
NPI:1477790400
Name:HILDEBRANDT, JENORES G
Entity Type:Individual
Prefix:
First Name:JENORES
Middle Name:G
Last Name:HILDEBRANDT
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:PO BOX 454
Mailing Address - Street 2:
Mailing Address - City:GROESBECK
Mailing Address - State:TX
Mailing Address - Zip Code:76642-0454
Mailing Address - Country:US
Mailing Address - Phone:903-644-5592
Mailing Address - Fax:
Practice Address - Street 1:504 W 6TH STREET
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:TX
Practice Address - Zip Code:76687
Practice Address - Country:US
Practice Address - Phone:903-644-5592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor