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General NPI Number Information
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NPI Number | 1912938374
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Entity Type | Individual
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Provider Name | JEANNE M HENNEMANN M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 01/16/2024
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Provider Practice Location Address
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Address Line | 3848 FAU BLVD
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City | BOCA RATON
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State | FL
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Zip | 33431-6437
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Country | US
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Telephone | 708-468-9599
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Fax |
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Provider Business Mailing Address
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Address Line | 3848 FAU BLVD
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City | BOCA RATON
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State | FL
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Zip | 33431-6437
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Country | US
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Telephone |
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME49374
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License Number State | FL
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