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Individual
MR. JESSE LEE HENNEBERG
Active
Individual
MR. JESSE LEE HENNEBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APN
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
209009916
IL
363LN0005X
Critical Care Neonatal Nurse Practitioner
209009916
IL
Other
Enumeration date
10/14/2012
Last updated
07/19/2021
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