Provider Demographics
NPI:1134439466
Name:HEGELAND, ANNI KRISTINE
Entity type:Individual
Prefix:
First Name:ANNI
Middle Name:KRISTINE
Last Name:HEGELAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BROOKHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:SOUND BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11789-1214
Mailing Address - Country:US
Mailing Address - Phone:631-338-2894
Mailing Address - Fax:
Practice Address - Street 1:11 BROOKHAVEN DR
Practice Address - Street 2:
Practice Address - City:SOUND BEACH
Practice Address - State:NY
Practice Address - Zip Code:11789-1214
Practice Address - Country:US
Practice Address - Phone:631-338-2894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6323511163W00000X
NY632351-1163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163W00000XNursing Service ProvidersRegistered Nurse