Provider Demographics
NPI:1861785230
Name:GEBAUER, HILARY (MPH, RD, LD)
Entity type:Individual
Prefix:
First Name:HILARY
Middle Name:
Last Name:GEBAUER
Suffix:
Gender:F
Credentials:MPH, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 HIGHWAY 100 S
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1529
Mailing Address - Country:US
Mailing Address - Phone:651-645-5323
Mailing Address - Fax:952-746-9562
Practice Address - Street 1:1660 HIGHWAY 100 S
Practice Address - Street 2:SUITE 250
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1529
Practice Address - Country:US
Practice Address - Phone:651-645-5323
Practice Address - Fax:952-746-9562
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3015133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered