Healthcare Provider Details

I. General information

NPI: 1629267885
Provider Name (Legal Business Name): DEBRA M HENNING MSN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 05/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2481 PROFESSIONAL CT
LV NV
89128
US

IV. Provider business mailing address

2481 PROFESSIONAL CT
LV NV
89128
US

V. Phone/Fax

Practice location:
  • Phone: 702-382-1599
  • Fax: 702-240-4962
Mailing address:
  • Phone: 702-382-1599
  • Fax: 702-240-4962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN000984
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: