Provider Demographics
NPI:1841599354
Name:HILDNER, ANDREW DUFFIELD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:DUFFIELD
Last Name:HILDNER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 PROFESSIONAL LN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6972
Mailing Address - Country:US
Mailing Address - Phone:303-772-1600
Mailing Address - Fax:303-772-9317
Practice Address - Street 1:1551 PROFESSIONAL LN
Practice Address - Street 2:SUITE 200
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6972
Practice Address - Country:US
Practice Address - Phone:303-772-1600
Practice Address - Fax:303-772-9317
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3169363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO43274005Medicaid