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Individual

BRAD E. HENNEMANN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
APRN, BC-FNP

Contact information

Practice address
212 HOSPITAL LANE, SUITE 101, PERRYVILLE, MO 63775-4204
(573) 547-7888
(573) 547-5481
Mailing address
212 HOSPITAL LANE, SUITE 101, PERRYVILLE, MO 63775-4204
(573) 547-7888
(573) 547-5481

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
151241
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
429126204
MO
Enumeration date
09/29/2006
Last updated
05/01/2008
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