Healthcare Provider Details

I. General information

NPI: 1366802399
Provider Name (Legal Business Name): TERESA HEGWOOD FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 CHASE RD STE 210
DEARBORN MI
48126-0900
US

IV. Provider business mailing address

393 ROOSEVELT AVE E
BATTLE CREEK MI
49017-3333
US

V. Phone/Fax

Practice location:
  • Phone: 832-869-4818
  • Fax: 832-241-2902
Mailing address:
  • Phone: 269-215-1253
  • Fax: 577-733-4806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number848359
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704302567
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704302567
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71014488A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: