Provider Demographics
NPI:1003425042
Name:HENNEN, REBECCA J (APRN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:HENNEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 KESSEL CT APT 33
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-6248
Mailing Address - Country:US
Mailing Address - Phone:262-408-0234
Mailing Address - Fax:
Practice Address - Street 1:84 KESSEL CT APT 33
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-6248
Practice Address - Country:US
Practice Address - Phone:262-408-0234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5015151363LP0808X
WI195980-30390200000X
CT151655390200000X
WI11715-33363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program