MEDICARE: ADRIENNE P HENN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant	100069124	FL

General Provider Information

NPI Number	:	1518460609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIENNE P HENN

Provider Business Mailing Address
First Line	:	95024 RAINTREE LN
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-7105
Country	:	US
Telephone Number	:	513-557-6415
Fax Number	:

Provider Business Practice Location Address
First Line	:	95024 RAINTREE LN
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-7105
Country	:	US
Telephone Number	:	513-557-6415
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2018
Last Update Date	:	03/14/2018

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Directions to “ ADRIENNE P HENN ” Practice Location

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