Healthcare Provider Details

I. General information

NPI: 1104582535
Provider Name (Legal Business Name): SARA HEGG CNP, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 8TH AVE NE
ABERDEEN SD
57401-3242
US

IV. Provider business mailing address

2120 8TH AVE NE
ABERDEEN SD
57401-3242
US

V. Phone/Fax

Practice location:
  • Phone: 605-725-4772
  • Fax: 605-725-4777
Mailing address:
  • Phone: 605-725-4772
  • Fax: 605-725-4777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberCP002200
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: