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General NPI Number Information
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NPI Number | 1497064166
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Entity Type | Individual
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Provider Name | MEGAN Q HENNINGS PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/29/2010
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Last Update Date | 03/13/2014
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Provider Practice Location Address
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Address Line | 2100 POWELL ST SUITE 920
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City | EMERYVILLE
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State | CA
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Zip | 94608-1826
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Country | US
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Telephone | 888-267-3880
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Fax | 510-879-9100
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Provider Business Mailing Address
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Address Line | 2100 POWELL ST SUITE 920
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City | EMERYVILLE
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State | CA
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Zip | 94608-1826
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Country | US
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Telephone | 888-267-3880
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Fax | 510-879-9100
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085-003844
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License Number State | IL
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