Provider Demographics
NPI:1003131137
Name:HENNE, HEATHER MARIE (MD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:HENNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 POWELL AVE SW
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2908
Mailing Address - Country:US
Mailing Address - Phone:206-870-3590
Mailing Address - Fax:425-277-1566
Practice Address - Street 1:955 POWELL AVE SW
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2908
Practice Address - Country:US
Practice Address - Phone:206-870-3590
Practice Address - Fax:425-277-1566
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60351094208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics