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General NPI Number Information
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NPI Number | 1104879592
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Entity Type | Individual
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Provider Name | AMY RENEE HENNE MD
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Gender | Female
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 12/27/2021
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Provider Practice Location Address
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Address Line | 7782 20TH AVE
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City | JENISON
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State | MI
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Zip | 49428-8524
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Country | US
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Telephone | 616-685-8700
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Fax | 616-457-5567
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Provider Business Mailing Address
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Address Line | 1900 44TH ST SE
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City | KENTWOOD
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State | MI
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Zip | 49508-5008
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Country | US
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Telephone | 616-685-1808
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301072799
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License Number State | MI
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