Provider Demographics
NPI:1659679454
Name:HILDERBRANT, SHELLEY ELIZABETH
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:ELIZABETH
Last Name:HILDERBRANT
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 1:325 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:CO
Mailing Address - Zip Code:80615
Mailing Address - Country:US
Mailing Address - Phone:970-988-7406
Mailing Address - Fax:
Practice Address - Street 1:200 S CHERRY AVE
Practice Address - Street 2:UNIT 2 SUITE B
Practice Address - City:EATON
Practice Address - State:CO
Practice Address - Zip Code:80615
Practice Address - Country:US
Practice Address - Phone:970-988-7406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2399225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist