Provider Demographics
NPI:1275140683
Name:HENNINGER, AMY LYN (BSN, RN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYN
Last Name:HENNINGER
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 N THEATRE DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-1700
Mailing Address - Country:US
Mailing Address - Phone:317-439-9492
Mailing Address - Fax:
Practice Address - Street 1:830 N THEATRE DR STE B
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-1700
Practice Address - Country:US
Practice Address - Phone:317-439-9492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28201917A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse