Provider Demographics
NPI:1528833753
Name:HESER, GWENDOLYN IRENE
Entity type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:IRENE
Last Name:HESER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 77
Mailing Address - Street 2:
Mailing Address - City:PARKMAN
Mailing Address - State:WY
Mailing Address - Zip Code:82838-0077
Mailing Address - Country:US
Mailing Address - Phone:307-752-0396
Mailing Address - Fax:
Practice Address - Street 1:10131 S HERITAGE RD
Practice Address - Street 2:
Practice Address - City:CROW AGENCY
Practice Address - State:MT
Practice Address - Zip Code:59022-7091
Practice Address - Country:US
Practice Address - Phone:406-638-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY44018163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse