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General NPI Number Information
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NPI Number | 1528833753
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Entity Type | Individual
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Provider Name | MS. GWENDOLYN IRENE HESER
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Gender | Female
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Dates
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Enumeration Date | 11/17/2023
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Last Update Date | 11/17/2023
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Provider Practice Location Address
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Address Line | 10131 S HERITAGE RD
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City | CROW AGENCY
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State | MT
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Zip | 59022-7091
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Country | US
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Telephone | 406-638-9111
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 77
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City | PARKMAN
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State | WY
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Zip | 82838-0077
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Country | US
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Telephone | 307-752-0396
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 44018
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License Number State | WY
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