MEDICARE: MS. NANCY JEAN HENGEVELD M.S., L.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	1442	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2H167HE	OTHER	MN	BLUE CROSS BLUE SHIELD MN
2	111791	OTHER	MN	UCARE

General Provider Information

NPI Number	:	1770668246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NANCY JEAN HENGEVELD M.S., L.P.

Provider Business Mailing Address
First Line	:	300 3RD AVE SE
Second Line	:	SUITE 201
City	:	ROCHESTER
State	:	MN
Zip	:	55904-4619
Country	:	US
Telephone Number	:	507-286-1227
Fax Number	:	507-281-2589

Provider Business Practice Location Address
First Line	:	300 3RD AVE SE
Second Line	:	SUITE 201
City	:	ROCHESTER
State	:	MN
Zip	:	55904-4619
Country	:	US
Telephone Number	:	507-286-1227
Fax Number	:	507-281-2589

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	07/08/2007

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