Basic Information
| Provider Information | |||||||||
| NPI: | 1043477011 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEDQUIST | ||||||||
| FirstName: | NANCY | ||||||||
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| Credential: | RNFA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 529 | ||||||||
| Address2: | |||||||||
| City: | ZEPHYR COVE | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894480529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7755888938 | ||||||||
| FaxNumber: | 7755888930 | ||||||||
| Practice Location | |||||||||
| Address1: | 1139 3RD ST | ||||||||
| Address2: | |||||||||
| City: | SOUTH LAKE TAHOE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 961503465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305413100 | ||||||||
| FaxNumber: | 5305413016 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2008 | ||||||||
| LastUpdateDate: | 05/19/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WR0006X | 507306 | CA | Y | Nursing Service Providers | Registered Nurse | Registered Nurse First Assistant |
No ID Information.