Healthcare Provider Details

I. General information

NPI: 1124280649
Provider Name (Legal Business Name): THERESA ANNE HEGGE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: THERESA ANNE ROSENDAHL MD, MPH

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 N 7TH ST 300 N 7TH ST
BISMARCK ND
58501
US

IV. Provider business mailing address

222 N 7TH ST 300 N 7TH ST
BISMARCK ND
58501
US

V. Phone/Fax

Practice location:
  • Phone: 701-323-5301
  • Fax: 701-323-5886
Mailing address:
  • Phone: 701-323-5301
  • Fax: 701-323-5886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number12751
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number12751
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: