Individual
KARLA MAY HENNEQUIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
3345 39TH ST S, FARGO, ND 58104-7539
(877) 522-1275
Mailing address
500 SW 7TH ST STE A205, RENTON, WA 98057-2983
(877) 522-1275
(833) 888-7145
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
103066
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7392724
AETNA
—
01
—
A2437
MEDCOST
—
Enumeration date
11/30/2005
Last updated
03/06/2025
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