Provider Demographics
NPI:1518905652
Name:HENINGER, WENDELIN MARIE (MD)
Entity Type:Individual
Prefix:
First Name:WENDELIN
Middle Name:MARIE
Last Name:HENINGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W. SPRINGDALE AVENUE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-4217
Mailing Address - Country:US
Mailing Address - Phone:865-329-9006
Mailing Address - Fax:865-329-9007
Practice Address - Street 1:201 W SPRINGDALE AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-5158
Practice Address - Country:US
Practice Address - Phone:865-329-9006
Practice Address - Fax:865-329-9007
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC02/21/20072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10777OtherBCBSNC GRP # 015HF
NC89-10777Medicaid
NC2238995CMedicare ID - Type UnspecifiedDR GRP # 2335660C