MEDICARE: THERESA LYNNE HENNIG RDN

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	133V00000X	Registered Dietitian	851869	TX

General Provider Information

NPI Number	:	1740985829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA LYNNE HENNIG RDN

Provider Business Mailing Address
First Line	:	3303 WINDSOR RANCH LN
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-4853
Country	:	US
Telephone Number	:	210-391-7031
Fax Number	:

Provider Business Practice Location Address
First Line	:	2115 STEPHENS PL STE 400B
Second Line	:
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78130-2167
Country	:	US
Telephone Number	:	210-439-1714
Fax Number	:	830-730-5652

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

Provider Enumeration Date	:	03/30/2023
Last Update Date	:	03/30/2023

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