Provider Demographics
NPI:1417323312
Name:HEDAHL, TANYA (LAC)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:HEDAHL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5720 S ALAMEDA ST
Mailing Address - Street 2:SUITE #114
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-3230
Mailing Address - Country:US
Mailing Address - Phone:361-236-5355
Mailing Address - Fax:
Practice Address - Street 1:5720 S ALAMEDA ST
Practice Address - Street 2:SUITE #114
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-3230
Practice Address - Country:US
Practice Address - Phone:361-236-5355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01590171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist