Healthcare Provider Details

I. General information

NPI: 1932808706
Provider Name (Legal Business Name): TAKESHA DIANE HEDGMAN DNP, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MEDICAL CENTER BLVD PROFESSIONAL OFFICE BUILDING 1, SUITE 305
UPLAND PA
19013-3995
US

IV. Provider business mailing address

1964 STERLING ST
PHILADELPHIA PA
19138-2228
US

V. Phone/Fax

Practice location:
  • Phone: 610-874-6448
  • Fax:
Mailing address:
  • Phone: 267-456-1502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number144212
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: