Healthcare Provider Details

I. General information

NPI: 1427523232
Provider Name (Legal Business Name): PAMELA CLAIRE HEGNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2018
Last Update Date: 10/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1643 EUREKA RD
ROSEVILLE CA
95661-3027
US

IV. Provider business mailing address

2044 TARBOLTON CIR
FOLSOM CA
95630-6132
US

V. Phone/Fax

Practice location:
  • Phone: 916-784-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number15526
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: