Healthcare Provider Details

I. General information

NPI: 1679919682
Provider Name (Legal Business Name): TINA RACHELLE HENNIGER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 1/2 FRONT ST
MARIETTA OH
45750-2908
US

IV. Provider business mailing address

PO BOX 146
LOWELL OH
45744-0146
US

V. Phone/Fax

Practice location:
  • Phone: 740-434-7613
  • Fax:
Mailing address:
  • Phone: 740-434-7613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN.CNP.16945
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: