Provider Demographics
NPI:1134167869
Name:HEGMANN, THERESA E (PA-C)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:E
Last Name:HEGMANN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-337-0593
Mailing Address - Fax:319-339-1449
Practice Address - Street 1:201 S CLINTON ST
Practice Address - Street 2:SUITE 195
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-4034
Practice Address - Country:US
Practice Address - Phone:319-638-4052
Practice Address - Fax:319-384-0603
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA937363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA970024057OtherRAILROAD MEDICARE
R04334Medicare UPIN
IAI0594Medicare PIN