Provider Demographics
NPI:1790964336
Name:HEGDAL, JULIET KAREN (FNP)
Entity Type:Individual
Prefix:
First Name:JULIET
Middle Name:KAREN
Last Name:HEGDAL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 769
Mailing Address - Street 2:
Mailing Address - City:REDWAY
Mailing Address - State:CA
Mailing Address - Zip Code:95560-0769
Mailing Address - Country:US
Mailing Address - Phone:707-923-2783
Mailing Address - Fax:707-923-2543
Practice Address - Street 1:101 WEST COAST RD.
Practice Address - Street 2:
Practice Address - City:REDWAY
Practice Address - State:CA
Practice Address - Zip Code:95560-0769
Practice Address - Country:US
Practice Address - Phone:707-923-2783
Practice Address - Fax:707-923-2543
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17324363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ07260ZMedicare PIN