1043383409 NPI number — MRS. VELVA H WOOLLEN HILKE MSR, PT

Table of content: MRS. VELVA H WOOLLEN HILKE MSR, PT (NPI 1043383409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043383409 NPI number — MRS. VELVA H WOOLLEN HILKE MSR, PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOOLLEN HILKE
Provider First Name:
VELVA
Provider Middle Name:
H
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSR, PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HILKE
Provider Other First Name:
HAYDEN
Provider Other Middle Name:
WOOLLEN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSR, PT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1043383409
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 729
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILSON
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
83014-0729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-699-7667
Provider Business Mailing Address Fax Number:
307-200-6597

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1230 N FALL CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILSON
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
83014-5058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-345-9676
Provider Business Practice Location Address Fax Number:
307-200-6597
Provider Enumeration Date:
11/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  1220 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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