Individual
BRENDA S HENNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.C.
Contact information
Practice address
3931 LOUISIANA AVE S, ST LOUIS PARK, MN 55426-5000
(952) 993-3123
Mailing address
8170 33RD AVE S # MS 21110Q, BLOOMINGTON, MN 55425-4516
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9389
MN
363AM0700X
Medical Physician Assistant
9389
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
290006887
RAILROAD MEDICARE
MN
Enumeration date
07/20/2006
Last updated
03/09/2021
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