Provider Demographics
NPI:1265577746
Name:HILLESHEIM, NADINE ANN
Entity type:Individual
Prefix:
First Name:NADINE
Middle Name:ANN
Last Name:HILLESHEIM
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 1:4033 39TH ST S
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-6942
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1201 25TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-2311
Practice Address - Country:US
Practice Address - Phone:701-451-4900
Practice Address - Fax:701-451-5057
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND464-8-15-01-29101YP2500X
MN0777103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND2078682OtherCIGNA
ND21678OtherBCBSND
ND58103-A006OtherTRIWEST
NDHP35520OtherHEALTH PARTNERS
MN8L049KLOtherBCBSMN
ND3100200501OtherPRIMEWEST
ND2352435OtherAMERICA'S PPO
ND62-06074OtherMEDICA UBH