Healthcare Provider Details

I. General information

NPI: 1487782363
Provider Name (Legal Business Name): GWEN F HEJNA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 EAST MEDICAL CENTER DR B1 FLOOR CANCER & GERIATRICS CTR RECP C
ANN ARBOR MI
48109-0916
US

IV. Provider business mailing address

3621 S STATE ST 700 KMS PLACE
ANN ARBOR MI
48108
US

V. Phone/Fax

Practice location:
  • Phone: 734-936-6000
  • Fax:
Mailing address:
  • Phone: 734-936-2047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601002910
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: