Healthcare Provider Details

I. General information

NPI: 1679506562
Provider Name (Legal Business Name): CHRISTINA M HENNEBERRY NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N CHILDRENS PLZ
CHICAGO IL
60614-3363
US

IV. Provider business mailing address

9230 W 138TH ST
ORLAND PARK IL
60462-1378
US

V. Phone/Fax

Practice location:
  • Phone: 773-880-4381
  • Fax:
Mailing address:
  • Phone: 708-873-9744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: