Provider Demographics
NPI:1568730588
Name:HEDMAN, DAVID BENJAMIN (CRNA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:BENJAMIN
Last Name:HEDMAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 ROOT RD
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-9755
Mailing Address - Country:US
Mailing Address - Phone:908-723-5210
Mailing Address - Fax:
Practice Address - Street 1:593 ROOT RD
Practice Address - Street 2:
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-9755
Practice Address - Country:US
Practice Address - Phone:908-723-5210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22644852163WC0200X
NY118380367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04158617798Medicaid