1730271966 NPI number — KATHLEEN WOOD HEDBERG APRN

Table of content: KATHLEEN WOOD HEDBERG APRN (NPI 1730271966)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730271966 NPI number — KATHLEEN WOOD HEDBERG APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEDBERG
Provider First Name:
KATHLEEN
Provider Middle Name:
WOOD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WOOD HEDBERG
Provider Other First Name:
KATHLEEN
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1730271966
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16 HOSPITAL RD
Provider Second Line Business Mailing Address:
SPEARE MEMORIAL HOSPITAL
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03264-1126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-536-1120
Provider Business Mailing Address Fax Number:
603-536-2017

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16 HOSPITAL RD
Provider Second Line Business Practice Location Address:
SMH DBA: WOUND CARE & HYPERBARIC MEDICINE
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03264-1126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-536-1120
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  0439812303 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 04398121 . This is a "RN LICENSE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 0439812303 . This is a "ARNP FNP LICENSE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".