Provider Demographics
NPI:1932808706
Name:HEDGMAN, TAKESHA DIANE (DNP, CRNA)
Entity Type:Individual
Prefix:
First Name:TAKESHA
Middle Name:DIANE
Last Name:HEDGMAN
Suffix:
Gender:F
Credentials:DNP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1964 STERLING ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19138-2228
Mailing Address - Country:US
Mailing Address - Phone:267-456-1502
Mailing Address - Fax:
Practice Address - Street 1:30 MEDICAL CENTER BLVD
Practice Address - Street 2:PROFESSIONAL OFFICE BUILDING 1, SUITE 305
Practice Address - City:UPLAND
Practice Address - State:PA
Practice Address - Zip Code:19013-3995
Practice Address - Country:US
Practice Address - Phone:610-874-6448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA144212367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered