Healthcare Provider Details

I. General information

NPI: 1770907404
Provider Name (Legal Business Name): JANECE HIEGEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2014
Last Update Date: 02/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16112 PATRIOT DR
LITTLE ROCK AR
72212-2669
US

IV. Provider business mailing address

16112 PATRIOT DR
LITTLE ROCK AR
72212-2669
US

V. Phone/Fax

Practice location:
  • Phone: 501-224-7817
  • Fax:
Mailing address:
  • Phone: 501-224-7817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE1722
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: