Healthcare Provider Details

I. General information

NPI: 1275832073
Provider Name (Legal Business Name): ALISHA MARIE HARRINGTON HEGEWALD DO, MACOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2011
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 NW SAMARITAN DR # D
CORVALLIS OR
97330-5472
US

IV. Provider business mailing address

3600 NW SAMARITAN DR # D
CORVALLIS OR
97330-5472
US

V. Phone/Fax

Practice location:
  • Phone: 541-768-4906
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC153161
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPG215984
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: