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General NPI Number Information
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NPI Number | 1639375900
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Entity Type | Individual
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Provider Name | KAREN THERESE HENNESSY RDH
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Gender | Female
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1647 16TH AVE NW
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City | ROCHESTER
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State | MN
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Zip | 55901-1650
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Country | US
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Telephone | 507-282-4401
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Fax |
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Provider Business Mailing Address
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Address Line | 620 E MAIN ST
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City | LEWISTON
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State | MN
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Zip | 55952-1209
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Country | US
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Telephone | 507-523-3227
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | H5755
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License Number State | MN
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