Individual
THERESA ANN HENNESSEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
SHRINERS HOSPITALS FOR CHILDREN, FAIRFAX ROAD AT VIRGINIA STREET, SALT LAKE CITY, UT 84103-4399
(801) 536-3600
(801) 536-3868
Mailing address
SHRINERS HOSPITALS FOR CHILDREN SALT, DEPT 5034, LOS ANGELES, CA 90084-0001
(813) 281-8478
(813) 281-8113
Taxonomy
Speciality
Code
Description
License number
State
207XP3100X
Pediatric Orthopaedic Surgery Physician
Primary
5897436-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5897436-1205
STATE LICENSE
UT
01
—
5897436-8905
CONTROLLED SUBSTANCE LIC
UT
Enumeration date
01/16/2007
Last updated
03/07/2023
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