Healthcare Provider Details

I. General information

NPI: 1235646506
Provider Name (Legal Business Name): TRACY L. HENNINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2018
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1469 8TH AVE
BETHLEHEM PA
18018-2256
US

IV. Provider business mailing address

1469 8TH AVE
BETHLEHEM PA
18018-2256
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-7800
  • Fax:
Mailing address:
  • Phone: 484-526-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP018162
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: