Individual
JONATHON HENNINGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4006 JOHNATHAN ST STE B, WATERLOO, IA 50701-9395
(319) 233-2663
Mailing address
PO BOX 2758, WATERLOO, IA 50704-2758
(319) 235-5390
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
A-114650
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
076372
—
IA
Enumeration date
05/05/2009
Last updated
02/07/2022
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