Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 0102201628 | VA |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 0102201628 | VA |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | R0412 | TX |
NPI | 1356312359 |
---|---|
Provider Name | Dr. Amy Elizabeth Henning |
First Address | Lubbock, TX 79410-1105 |
Second Address | Lubbock, TX 79410-1805 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2006 |
Last Update Date | 24/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
367943301 | (05) | TX |
557830YKT8 | TX MEDICARE (01) | TX |
8GK818 | BCBS TX (01) | TX |