Healthcare Provider Details

I. General information

NPI: 1801800818
Provider Name (Legal Business Name): ARNELLA C HENNIG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 02/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 OAK ST SE SUITE 1080
SALEM OR
97301-3975
US

IV. Provider business mailing address

PO BOX 391
SALEM OR
97308-0391
US

V. Phone/Fax

Practice location:
  • Phone: 503-561-5294
  • Fax: 503-561-4789
Mailing address:
  • Phone: 503-561-5135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD17429
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: