Healthcare Provider Details

I. General information

NPI: 1003131137
Provider Name (Legal Business Name): HEATHER MARIE HENNE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 07/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 POWELL AVE SW
RENTON WA
98057-2908
US

IV. Provider business mailing address

955 POWELL AVE SW
RENTON WA
98057-2908
US

V. Phone/Fax

Practice location:
  • Phone: 206-870-3590
  • Fax: 425-277-1566
Mailing address:
  • Phone: 206-870-3590
  • Fax: 425-277-1566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD60351094
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: