Provider Demographics
NPI:1225382641
Name:HENNING, MOLLY BETH (RN)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:BETH
Last Name:HENNING
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 290
Mailing Address - Street 2:39 SHORT CUT RD
Mailing Address - City:INCHELIUM
Mailing Address - State:WA
Mailing Address - Zip Code:99138-0290
Mailing Address - Country:US
Mailing Address - Phone:509-722-7006
Mailing Address - Fax:509-722-7021
Practice Address - Street 1:39 SHORT CUT RD
Practice Address - Street 2:
Practice Address - City:INCHELIUM
Practice Address - State:WA
Practice Address - Zip Code:99138-0290
Practice Address - Country:US
Practice Address - Phone:509-722-7006
Practice Address - Fax:509-722-7021
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00146340163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse