Provider Demographics
NPI:1275064776
Name:MUNNIKHUYSEN, SENNA RAE (MD)
Entity Type:Individual
Prefix:
First Name:SENNA
Middle Name:RAE
Last Name:MUNNIKHUYSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1800 ORLEANS ST STE 11379
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-0010
Mailing Address - Country:US
Mailing Address - Phone:410-955-8751
Mailing Address - Fax:410-955-0028
Practice Address - Street 1:800 ROSE ST STE C400
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0010
Practice Address - Country:US
Practice Address - Phone:859-257-4554
Practice Address - Fax:859-257-8978
Is Sole Proprietor?:No
Enumeration Date:2017-03-26
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0089359208000000X
KYR4564208000000X
KY581082080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics