Mr. Jesse Lee Henneberg
Nurse Practitioner - Neonatal Nurse Practitioner - Neonatal (Critical Care)
530 Ne Glen Oak Ave
Peoria
, Illinois 61637-0001
Mr. Jesse Lee Henneberg
Nurse Practitioner - Neonatal Nurse Practitioner - Neonatal (Critical Care)
530 Ne Glen Oak Ave
Peoria
, Illinois 61637-0001
(217) 545-7731
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About
Features
Specialties
- Nurse Practitioner - Neonatal
- Nurse Practitioner - Neonatal (Critical Care)
Languages spoken
- English
Location
First Address
- Mr. Jesse Lee Henneberg
- 201 E Madison St Ste 328
- Springfield, IL
- Zip : 62702-5131
- Phone : (217) 545-7731
Second Address
- Mr. Jesse Lee Henneberg
- 530 Ne Glen Oak Ave
- Peoria, IL
- Zip : 61637-0001
- Phone : (309) 624-0629
Reviews
FAQs
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Is Mr. Jesse Lee Henneberg a sole practitioner?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 363LN0000X | Nurse Practitioner - Neonatal | 209009916 | IL |
| N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 209009916 | IL |
National Provider Identifier
| NPI | 1316299456 |
|---|---|
| Provider Name | Mr. Jesse Lee Henneberg |
| First Address | Springfield, IL 62702-5131 |
| Second Address | Peoria, IL 61637-0001 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 14/10/2012 |
| Last Update Date | 19/07/2021 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.