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NPI Code Detail

MEDICARE: MICHAELA HENNEBERRY DNP, ARNP, FNP-C

MEDICARE: MICHAELA HENNEBERRY DNP, ARNP, FNP-C
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
1363LF0000XFamily Nurse PractitionerA189940IA

General Provider Information

NPI Number : 1639003809
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAELA HENNEBERRY DNP, ARNP, FNP-C
Provider Business Mailing Address
First Line : 6800 LAKE DR STE 285
Second Line :
City : WEST DES MOINES
State : IA
Zip : 50266-2544
Country : US
Telephone Number : 515-226-3116
Fax Number : 515-223-9341
Provider Business Practice Location Address
First Line : 1005 BLAIRS FERRY RD NE STE 30
Second Line :
City : CEDAR RAPIDS
State : IA
Zip : 52402-1292
Country : US
Telephone Number : 319-289-7779
Fax Number : 319-320-4644
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2026
Last Update Date : 06/11/2026

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