Provider Demographics
NPI:1467706911
Name:HENNESSEY, ERIN MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:MARIE
Last Name:HENNESSEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7015 LIGHTHOUSE WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-7018
Mailing Address - Country:US
Mailing Address - Phone:419-520-7546
Mailing Address - Fax:
Practice Address - Street 1:7015 LIGHTHOUSE WAY STE 300
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-7018
Practice Address - Country:US
Practice Address - Phone:419-377-9294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-06
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704267841363LF0000X
OH14277363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily