Provider Demographics
NPI:1124280649
Name:HEGGE, THERESA ANNE (MD)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:ANNE
Last Name:HEGGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:ANNE
Other - Last Name:ROSENDAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:222 N 7TH ST
Mailing Address - Street 2:300 N 7TH ST
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501
Mailing Address - Country:US
Mailing Address - Phone:701-323-5301
Mailing Address - Fax:701-323-5886
Practice Address - Street 1:222 N 7TH ST
Practice Address - Street 2:300 N 7TH ST
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501
Practice Address - Country:US
Practice Address - Phone:701-323-5301
Practice Address - Fax:701-323-5886
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND12751208200000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1461056Medicaid