Provider Demographics
NPI:1689979619
Name:HENNEN, CHERYL ELAINE
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ELAINE
Last Name:HENNEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:OLIVIA
Mailing Address - State:MN
Mailing Address - Zip Code:56277-1205
Mailing Address - Country:US
Mailing Address - Phone:320-522-2382
Mailing Address - Fax:
Practice Address - Street 1:210 S 10TH ST
Practice Address - Street 2:
Practice Address - City:OLIVIA
Practice Address - State:MN
Practice Address - Zip Code:56277-1205
Practice Address - Country:US
Practice Address - Phone:320-522-2382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-23
Last Update Date:2011-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN350308163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health