Provider Demographics
NPI:1649238700
Name:HEBGEN, JOANNA R (PA-C)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:R
Last Name:HEBGEN
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 1:753 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:WI
Mailing Address - Zip Code:53575-1003
Mailing Address - Country:US
Mailing Address - Phone:608-835-2222
Mailing Address - Fax:608-835-1090
Practice Address - Street 1:753 N MAIN ST
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:WI
Practice Address - Zip Code:53575-1003
Practice Address - Country:US
Practice Address - Phone:608-835-2222
Practice Address - Fax:608-835-1090
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1557363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1649238700Medicaid
WI61101OtherDEAN HEALTH INSURANCE
WI41969900Medicaid
WI61101OtherDEAN HEALTH INSURANCE