Provider Demographics
NPI:1578209466
Name:HEGGEN, LERISSA (HCHI, HCHD)
Entity Type:Individual
Prefix:
First Name:LERISSA
Middle Name:
Last Name:HEGGEN
Suffix:
Gender:F
Credentials:HCHI, HCHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 CHEDINGTON DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-8102
Mailing Address - Country:US
Mailing Address - Phone:191-038-1306
Mailing Address - Fax:
Practice Address - Street 1:2005 CHEDINGTON DR
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-8102
Practice Address - Country:US
Practice Address - Phone:910-381-3063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty