Provider Demographics
NPI:1417500364
Name:HENNIGAR, MOLLY (ARNP)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:HENNIGAR
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 KENT AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANELLE
Mailing Address - State:IA
Mailing Address - Zip Code:50846-8036
Mailing Address - Country:US
Mailing Address - Phone:641-745-7458
Mailing Address - Fax:
Practice Address - Street 1:609 SE KENT ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IA
Practice Address - Zip Code:50849-9454
Practice Address - Country:US
Practice Address - Phone:641-743-6189
Practice Address - Fax:641-743-7212
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA155737363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner