Doctor Name: | JENNIFER LOUISE HENNICK |
NPI Number: | 1083929541 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 19991 |
Business Practice Address: | 575 N Thompson Rd Tipton, CA - 932729756 |
Business Phone Number: | 5597524147 |
Business Fax Number: | 5597524150 |
Mailing Address: | 575 N Thompson Rd, TIPTON |
State: | CA |
Postal Code: | 932729756 |
Phone Number: | 5597524147 |
Fax Number: | 5597524150 |
NPI Enumeration Date: | 08/09/2010 |
NPI Last Update Date: | 08/17/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 19991 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |