Healthcare Provider Details

I. General information

NPI: 1497327118
Provider Name (Legal Business Name): CHETIA HEGGS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 07/13/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 SIRIUS CT
SEWELL NJ
08080-2028
US

IV. Provider business mailing address

45 SIRIUS CT
SEWELL NJ
08080-2028
US

V. Phone/Fax

Practice location:
  • Phone: 267-800-8710
  • Fax:
Mailing address:
  • Phone: 267-800-8710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLPN096438
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: