Healthcare Provider Details

I. General information

NPI: 1306319967
Provider Name (Legal Business Name): BRITTANY HEIDI HESSE ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64358 375TH ST
WATKINS MN
55389-5828
US

IV. Provider business mailing address

64358 375TH ST
WATKINS MN
55389-5828
US

V. Phone/Fax

Practice location:
  • Phone: 320-423-2423
  • Fax:
Mailing address:
  • Phone: 320-423-2423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1306319967
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: