Provider Demographics
NPI:1518415371
Name:HILLARY, KATHLEEN (RN,CDE,CFCS)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:HILLARY
Suffix:
Gender:F
Credentials:RN,CDE,CFCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 N SANTIAM HWY
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-4363
Mailing Address - Country:US
Mailing Address - Phone:541-451-7100
Mailing Address - Fax:
Practice Address - Street 1:525 NORTH SANTIAM HIGHWAY
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355
Practice Address - Country:US
Practice Address - Phone:541-451-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR90000185163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse