MEDICARE: LISA MARIE HENNINGS

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	376J00000X	Homemaker

General Provider Information

NPI Number	:	1871338830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MARIE HENNINGS

Provider Business Mailing Address
First Line	:	7083 NEFF RD
Second Line	:
City	:	VALLEY CITY
State	:	OH
Zip	:	44280-9524
Country	:	US
Telephone Number	:	330-304-2728
Fax Number	:

Provider Business Practice Location Address
First Line	:	7083 NEFF RD
Second Line	:
City	:	VALLEY CITY
State	:	OH
Zip	:	44280-9524
Country	:	US
Telephone Number	:	330-304-2728
Fax Number	:

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

Provider Enumeration Date	:	07/01/2024
Last Update Date	:	07/01/2024

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Directions to “ LISA MARIE HENNINGS ” Practice Location

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