| Doctor Name: | MRS. MARY ELLEN HENNIGAN |
| NPI Number: | 1679881874 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | R.N. |
| License Number: | 285847-1 |
| Business Practice Address: | 72 State St Skaneateles, NY - 131521218 |
| Business Phone Number: | 3152912265 |
| Business Fax Number: | 3152912256 |
| Mailing Address: | 72 State St, SKANEATELES |
| State: | NY |
| Postal Code: | 131521218 |
| Phone Number: | 3152912265 |
| Fax Number: | 3152912256 |
| NPI Enumeration Date: | 09/22/2010 |
| NPI Last Update Date: | 09/22/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WS0200X |
| License Number: | 285847-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |