Healthcare Provider Details

I. General information

NPI: 1093647943
Provider Name (Legal Business Name): DIANA LYNN HEGGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 CHERRY ST APT 111
GRAND FORKS ND
58201-7630
US

IV. Provider business mailing address

709 S 16TH ST
GRAND FORKS ND
58201-4279
US

V. Phone/Fax

Practice location:
  • Phone: 701-610-6690
  • Fax:
Mailing address:
  • Phone: 701-610-6690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: