Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 11715-33 | WI |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 5015151 | NC |
NPI | 1003425042 |
---|---|
Provider Name | Rebecca J Hennen |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53792-6951 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2020 |
Last Update Date | 07/02/2022 |