Healthcare Provider Details

I. General information

NPI: 1700466596
Provider Name (Legal Business Name): FAITH ELIZABETH HENNEN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 CARLSON ST
MARSHALL MN
56258-2626
US

IV. Provider business mailing address

1521 CARLSON ST
MARSHALL MN
56258-2626
US

V. Phone/Fax

Practice location:
  • Phone: 507-476-4800
  • Fax:
Mailing address:
  • Phone: 507-476-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number14513
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number2463806
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: