Provider Demographics
NPI:1760279665
Name:HILDEBRANT, GRACE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:HILDEBRANT
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14150 HAMILTON LAKE RD
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:MI
Mailing Address - Zip Code:49868
Mailing Address - Country:US
Mailing Address - Phone:906-293-5107
Mailing Address - Fax:
Practice Address - Street 1:14150 HAMILTON LAKE RD
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:MI
Practice Address - Zip Code:49868
Practice Address - Country:US
Practice Address - Phone:906-293-5107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker