Individual
REBECCA HENNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
4272 CHURCH RD, LOCKPORT, NY 14094-9724
(716) 946-5901
Mailing address
7315 COLE RD, COLDEN, NY 14033-9741
(716) 946-5901
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
69042301
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
404561
NY
Other
Enumeration date
07/07/2022
Last updated
11/21/2023
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