Healthcare Provider Details

I. General information

NPI: 1891075909
Provider Name (Legal Business Name): CHRISTIN HEGRENESS WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2011
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14961 W BELL RD SUITE 175
SURPRISE AZ
85374-3200
US

IV. Provider business mailing address

14961 W BELL RD SUITE 175
SURPRISE AZ
85374-3200
US

V. Phone/Fax

Practice location:
  • Phone: 623-547-7205
  • Fax: 623-243-6733
Mailing address:
  • Phone: 623-547-7205
  • Fax: 623-243-6733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAP4031
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: