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:
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Other - Credentials:
Mailing Address - Street 1:2451 E BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2471
Mailing Address - Country:US
Mailing Address - Phone:480-494-2770
Mailing Address - Fax:480-494-2771
Practice Address - Street 1:520 N CAMINO MERCADO STE 1
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-5754
Practice Address - Country:US
Practice Address - Phone:520-557-5600
Practice Address - Fax:480-494-2771
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ258473363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology