Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | ME125560 | FL |
NPI | 1114190469 |
---|---|
Provider Name | Heather Ann Hedstrom |
First Address | Panama City, FL 32405-7609 |
Second Address | Panama City, FL 32405-7609 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2008 |
Last Update Date | 18/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016003400 | (05) | FL |