Healthcare Provider Details

I. General information

NPI: 1649032384
Provider Name (Legal Business Name): ERIN MACKENZIE HEGG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 W BASELINE RD STE 111
PHOENIX AZ
85041-6492
US

IV. Provider business mailing address

261 N ROOSEVELT AVE
CHANDLER AZ
85226-2617
US

V. Phone/Fax

Practice location:
  • Phone: 480-677-8282
  • Fax:
Mailing address:
  • Phone: 480-677-8282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number10416
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: