Provider Demographics
NPI:1225328248
Name:HENNESSEY, MARGARET MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:MARIE
Last Name:HENNESSEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:MARIE
Other - Last Name:BUCKNEER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1740 COOKS HILL RD
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-9071
Mailing Address - Country:US
Mailing Address - Phone:360-736-7623
Mailing Address - Fax:360-736-4497
Practice Address - Street 1:1740 COOKS HILL RD
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-9071
Practice Address - Country:US
Practice Address - Phone:360-736-7623
Practice Address - Fax:360-736-4497
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60127191363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily