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NPI Code Detail

MEDICARE: MRS. CLAIRE M HENNINGER RD, LD

MEDICARE: MRS. CLAIRE M HENNINGER RD, LD
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
1133V00000XRegistered DietitianND2417FL

General Provider Information

NPI Number : 1942363924
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CLAIRE M HENNINGER RD, LD
Provider Business Mailing Address
First Line : 18 INITIAL LN
Second Line :
City : SANTA ROSA BEACH
State : FL
Zip : 32459-3144
Country : US
Telephone Number : 850-267-1929
Fax Number :
Provider Business Practice Location Address
First Line : 597 W 11TH ST
Second Line :
City : PANAMA CITY
State : FL
Zip : 32401-2330
Country : US
Telephone Number : 850-872-4666
Fax Number : 850-872-7390
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2006
Last Update Date : 07/08/2007

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