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Individual

LAURA R HENNESS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
1030 MCINTOSH CIR, STE 2, JOPLIN, MO 64804-3642
(417) 782-9393
(417) 782-4659
Mailing address
PO BOX 3810, JOPLIN, MO 64803
(417) 782-9393
(417) 782-9393

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2000159837
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100196050A
OK
05
100398440A
KS
01
143108
ANTHEM
MO
05
205328206
MO
Enumeration date
06/21/2006
Last updated
01/26/2009
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