Healthcare Provider Details

I. General information

NPI: 1124410758
Provider Name (Legal Business Name): JODI HENNING R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2015
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 NW 114TH ST STE 305
CLIVE IA
50325-7012
US

IV. Provider business mailing address

1370 NW 114TH ST STE 305
CLIVE IA
50325-7012
US

V. Phone/Fax

Practice location:
  • Phone: 515-316-9505
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number129164
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG159700
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: