Healthcare Provider Details

I. General information

NPI: 1821281692
Provider Name (Legal Business Name): MICHAEL RICHARD HENNING ANP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11901 REEDY BRANCH RD
CHESTERFIELD VA
23838-4235
US

IV. Provider business mailing address

11901 REEDY BRANCH RD
CHESTERFIELD VA
23838-4235
US

V. Phone/Fax

Practice location:
  • Phone: 804-896-1499
  • Fax: 804-590-1872
Mailing address:
  • Phone: 804-896-1499
  • Fax: 804-590-1872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024167468
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: