Provider Demographics
NPI:1891075909
Name:HEGRENESS, CHRISTIN (WHNP)
Entity Type:Individual
Prefix:
First Name:CHRISTIN
Middle Name:
Last Name:HEGRENESS
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14961 W BELL RD
Mailing Address - Street 2:SUITE 175
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-3200
Mailing Address - Country:US
Mailing Address - Phone:623-547-7205
Mailing Address - Fax:623-243-6733
Practice Address - Street 1:14961 W BELL RD
Practice Address - Street 2:SUITE 175
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3200
Practice Address - Country:US
Practice Address - Phone:623-547-7205
Practice Address - Fax:623-243-6733
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4031363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z151066Medicare PIN