Healthcare Provider Details

I. General information

NPI: 1205229176
Provider Name (Legal Business Name): EMILY HENNING D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY FAUTH

II. Dates (important events)

Enumeration Date: 03/16/2015
Last Update Date: 05/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 HASLETT RD
HASLETT MI
48840-7615
US

IV. Provider business mailing address

3955 PATIENT CARE DR
LANSING MI
48911-4299
US

V. Phone/Fax

Practice location:
  • Phone: 517-853-5576
  • Fax: 517-853-5577
Mailing address:
  • Phone: 517-374-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5101024593
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: