Individual
DR. MARK HENNEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1540 HUMBOLDT AVE, SAINT PAUL, MN 55118-3417
(651) 457-2020
Mailing address
1613 ATWATER PATH, INVER GROVE HEIGHTS, MN 55077-1201
(651) 455-6631
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1944
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
237223100
—
MN
Enumeration date
07/01/2005
Last updated
07/29/2010
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