Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 779047 | TX |
NPI | 1124407242 |
---|---|
Provider Name | Kourtney Hennigan |
First Address | Sunrise, FL 33323-2896 |
Second Address | Sunrise, FL 33323-2896 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2015 |
Last Update Date | 21/05/2015 |