Healthcare Provider Details

I. General information

NPI: 1891276770
Provider Name (Legal Business Name): CAROLINE ELIZABETH HENNE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLINE E BASSETT PA-C

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 DELBON AVE
TURLOCK CA
95382-2016
US

IV. Provider business mailing address

525 FAIRBROOK ST APT 201
NORTHVILLE MI
48167-1347
US

V. Phone/Fax

Practice location:
  • Phone: 209-667-4200
  • Fax:
Mailing address:
  • Phone: 248-672-3982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0007368
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number55829
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: