Provider Demographics
NPI:1326470360
Name:HEGEMANN, EMILY ROSE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:ROSE
Last Name:HEGEMANN
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 1:5840 ROUTE 981
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-5397
Mailing Address - Country:US
Mailing Address - Phone:724-532-1118
Mailing Address - Fax:
Practice Address - Street 1:5840 ROUTE 981
Practice Address - Street 2:SUITE 101
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-5397
Practice Address - Country:US
Practice Address - Phone:724-532-1118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056270363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical