Healthcare Provider Details

I. General information

NPI: 1639003809
Provider Name (Legal Business Name): MICHAELA HENNEBERRY DNP, ARNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 BLAIRS FERRY RD NE STE 30
CEDAR RAPIDS IA
52402-1292
US

IV. Provider business mailing address

6800 LAKE DR STE 285
WEST DES MOINES IA
50266-2544
US

V. Phone/Fax

Practice location:
  • Phone: 319-289-7779
  • Fax: 319-320-4644
Mailing address:
  • Phone: 515-226-3116
  • Fax: 515-223-9341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA189940
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: