Healthcare Provider Details

I. General information

NPI: 1578232484
Provider Name (Legal Business Name): LYNNDSAY HEGBERG-OBISPO PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 S TRUMBULL ST
BAY CITY MI
48708-7692
US

IV. Provider business mailing address

3023 DAVENPORT AVE
SAGINAW MI
48602-3652
US

V. Phone/Fax

Practice location:
  • Phone: 517-375-5879
  • Fax:
Mailing address:
  • Phone: 989-922-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704290939
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: