Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 12751 | ND |
N | 208600000X | Surgeon | 12751 | ND |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 12751 | ND |
NPI | 1124280649 |
---|---|
Provider Name | Theresa Anne Hegge |
First Address | Bismarck, ND 58501-4439 |
Second Address | Bismarck, ND 58501-4436 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2008 |
Last Update Date | 04/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1461056 | (05) | ND |