Individual
MARK W HENNICKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
530 SOUTH ST, SECOND FLOOR, GREENSBURG, PA 15601-2775
(724) 689-1358
(724) 689-0547
Mailing address
520 JEFFERSON AVE, SUITE 400, JEANNETTE, PA 15644-2538
(724) 527-8060
(724) 522-4002
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA002773L
PA
Other
Enumeration date
04/26/2006
Last updated
11/17/2016
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