Healthcare Provider Details

I. General information

NPI: 1780836957
Provider Name (Legal Business Name): JOAN I HEDGES N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2008
Last Update Date: 10/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 NE 3RD ST
MCMINNVILLE OR
97128-4901
US

IV. Provider business mailing address

119 NE 3RD ST
MCMINNVILLE OR
97128-4901
US

V. Phone/Fax

Practice location:
  • Phone: 503-434-6515
  • Fax:
Mailing address:
  • Phone: 503-434-6515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number0499
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: