Provider Demographics
NPI:1588233175
Name:HENNIS, PETER PAUL MOHEB (AGNP)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:PAUL MOHEB
Last Name:HENNIS
Suffix:
Gender:M
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 S FOREST DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-3650
Mailing Address - Country:US
Mailing Address - Phone:910-315-0116
Mailing Address - Fax:
Practice Address - Street 1:281 S FOREST DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-3650
Practice Address - Country:US
Practice Address - Phone:910-315-0116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03210111363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology