Individual
THERESA ANN HENNESSEY
Active
Individual
THERESA ANN HENNESSEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
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
Update your record
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