1891276770 NPI number — CAROLINE ELIZABETH HENNE PA-C

Table of content: CAROLINE ELIZABETH HENNE PA-C (NPI 1891276770)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891276770 NPI number — CAROLINE ELIZABETH HENNE PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENNE
Provider First Name:
CAROLINE
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BASSETT
Provider Other First Name:
CAROLINE
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891276770
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
525 FAIRBROOK ST APT 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTHVILLE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48167-1347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-672-3982
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 DELBON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TURLOCK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95382-2016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-667-4200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/28/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA.0007368 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 55829 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)