Healthcare Provider Details

I. General information

NPI: 1649238700
Provider Name (Legal Business Name): JOANNA R HEBGEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

753 N MAIN ST
OREGON WI
53575-1003
US

IV. Provider business mailing address

753 N MAIN ST
OREGON WI
53575-1003
US

V. Phone/Fax

Practice location:
  • Phone: 608-835-2222
  • Fax: 608-835-1090
Mailing address:
  • Phone: 608-835-2222
  • Fax: 608-835-1090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1557
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1557
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: