Provider Demographics
NPI:1124584107
Name:HENSGEN, ADRIANNA ROSE
Entity Type:Individual
Prefix:
First Name:ADRIANNA
Middle Name:ROSE
Last Name:HENSGEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 S STANTON ST
Mailing Address - Street 2:
Mailing Address - City:SHANNON
Mailing Address - State:IL
Mailing Address - Zip Code:61078-9309
Mailing Address - Country:US
Mailing Address - Phone:815-238-7428
Mailing Address - Fax:
Practice Address - Street 1:1828 S WEST AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-6712
Practice Address - Country:US
Practice Address - Phone:815-233-5904
Practice Address - Fax:815-233-3177
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health