Provider Demographics
NPI:1992393052
Name:HILDRETH, DANIELLE J (RD, CPT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:J
Last Name:HILDRETH
Suffix:
Gender:F
Credentials:RD, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 53RD AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-6304
Mailing Address - Country:US
Mailing Address - Phone:701-367-1955
Mailing Address - Fax:
Practice Address - Street 1:1606 53RD AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-6304
Practice Address - Country:US
Practice Address - Phone:701-367-1955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND86058774133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered