Provider Demographics
NPI:1316349319
Name:HENNESSY, CHRISTINA MARIE (RN)
Entity type:Individual
Prefix:MISS
First Name:CHRISTINA
Middle Name:MARIE
Last Name:HENNESSY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 HUNT AVE
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-1868
Mailing Address - Country:US
Mailing Address - Phone:845-709-5082
Mailing Address - Fax:
Practice Address - Street 1:354 PHILLIPS HILL RD
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-2015
Practice Address - Country:US
Practice Address - Phone:917-648-8741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY688307-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYEA16409RMedicaid