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General NPI Number Information
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NPI Number | 1124584107
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Entity Type | Individual
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Provider Name | ADRIANNA ROSE HENSGEN
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Gender | Female
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Dates
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Enumeration Date | 02/14/2019
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Last Update Date | 02/14/2019
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Provider Practice Location Address
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Address Line | 1828 S WEST AVE
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City | FREEPORT
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State | IL
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Zip | 61032-6712
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Country | US
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Telephone | 815-233-5904
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Fax | 815-233-3177
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Provider Business Mailing Address
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Address Line | 1 S STANTON ST
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City | SHANNON
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State | IL
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Zip | 61078-9309
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Country | US
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Telephone | 815-238-7428
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | IL
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