MEDICARE: AMANDA JO HENNING MSN, NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	26NJ00760500	NJ
2	363LP2300X	Primary Care Nurse Practitioner	26NJ00760500	NJ
3	363L00000X	Nurse Practitioner	26NJ00760500	NJ
4	363LA2200X	Adult Health Nurse Practitioner	26NJ00760500	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	26NJ00760500	OTHER	NJ	STATE LICENSE

General Provider Information

NPI Number	:	1215456983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA JO HENNING MSN, NP-C

Provider Business Mailing Address
First Line	:	175 BELGRADE DR.
Second Line	:
City	:	KEARNY
State	:	NJ
Zip	:	07032
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	175 BELGRADE DR.
Second Line	:
City	:	KEARNY
State	:	NJ
Zip	:	07032
Country	:	US
Telephone Number	:	908-809-9130
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2017
Last Update Date	:	02/17/2026

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