Provider Demographics
NPI:1356074561
Name:HEBBE, KASTYN ALICE
Entity Type:Individual
Prefix:
First Name:KASTYN
Middle Name:ALICE
Last Name:HEBBE
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:W3064 HAGEDORN RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:WI
Mailing Address - Zip Code:53549-9745
Mailing Address - Country:US
Mailing Address - Phone:920-723-8447
Mailing Address - Fax:
Practice Address - Street 1:W3064 HAGEDORN RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:WI
Practice Address - Zip Code:53549-9745
Practice Address - Country:US
Practice Address - Phone:920-723-8447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program