Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 085.006662 | IL |
NPI | 1255881298 |
---|---|
Provider Name | Brenna Lauren Hennessey |
First Address | Oak Park, CA 91377-1051 |
Second Address | Chicago, IL 60611 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2016 |
Last Update Date | 03/08/2018 |