Provider Demographics
NPI:1134514334
Name:SHEILA A HOEMBERG LLC
Entity Type:Organization
Organization Name:SHEILA A HOEMBERG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HOEMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:218-371-7136
Mailing Address - Street 1:410 10TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WADENA
Mailing Address - State:MN
Mailing Address - Zip Code:56482-1039
Mailing Address - Country:US
Mailing Address - Phone:218-371-7136
Mailing Address - Fax:
Practice Address - Street 1:7760 EXCELSIOR RD
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-9767
Practice Address - Country:US
Practice Address - Phone:218-454-0878
Practice Address - Fax:218-454-0879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP0711251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health