Provider Demographics
NPI:1225417108
Name:HENNE, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HENNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 E TOWN ST
Mailing Address - Street 2:UNIT 110
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-4740
Mailing Address - Country:US
Mailing Address - Phone:614-506-2588
Mailing Address - Fax:
Practice Address - Street 1:451 E TOWN ST
Practice Address - Street 2:UNIT 110
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4740
Practice Address - Country:US
Practice Address - Phone:614-506-2588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-25
Last Update Date:2015-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH409160163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse