=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205223542
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER BERRIE HENNING M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2015
-----------------------------------------------------
Last Update Date | 03/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | WILFORD HALL AMBULATORY SURGICAL CENTER 1100 WILFORD HALL LOOP
-----------------------------------------------------
City | JBSA LACKLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-292-2931
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | WILFORD HALL AMBULATORY SURGICAL CENTER 1100 WILFORD HALL LOOP
-----------------------------------------------------
City | JBSA LACKLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 29575
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 036173905
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------