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: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

14406 NE 20TH AVE
VANCOUVER WA
98686-1448
US

V. Phone/Fax

Practice location:
  • Phone: 541-768-4906
  • Fax:
Mailing address:
  • Phone: 360-418-6001
  • Fax: 360-571-3109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO230911
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: