Individual
GINA MICHELLE HENNESSY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
702 GORDON DR, EXTON, PA 19341-1253
(610) 363-1330
(610) 524-8574
Mailing address
702 GORDON DR, EXTON, PA 19341-1253
(610) 363-1330
(610) 524-8574
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
SP010586
PA
363L00000X
Nurse Practitioner
SP010586
PA
363LP0200X
Pediatric Nurse Practitioner
LJ-0000276
DE
363LP2300X
Primary Care Nurse Practitioner
Primary
SP010586
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1026832780001
—
PA
Enumeration date
12/14/2009
Last updated
11/09/2020
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