Healthcare Provider Details

I. General information

NPI: 1437734738
Provider Name (Legal Business Name): PEGGY K HEGNA BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 NE EVANS ST
MCMINNVILLE OR
97128-3923
US

IV. Provider business mailing address

11800 SW FOX RIDGE RD
MCMINNVILLE OR
97128-8396
US

V. Phone/Fax

Practice location:
  • Phone: 503-434-7414
  • Fax:
Mailing address:
  • Phone: 503-789-1560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number079036743RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: