Provider Demographics
NPI:1992057038
Name:HEDBLOM, ANDREA (PA-C)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:HEDBLOM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4759
Mailing Address - Country:US
Mailing Address - Phone:406-457-0000
Mailing Address - Fax:
Practice Address - Street 1:630 N LAST CHANCE GULCH STE 1100
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3551
Practice Address - Country:US
Practice Address - Phone:406-457-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-14
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT59457363AM0700X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical