Provider Demographics
NPI:1760101562
Name:HENNEGAR, JENNY CATHERINE (APRN)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:CATHERINE
Last Name:HENNEGAR
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 1:4282 E ROCKTON RD
Mailing Address - Street 2:
Mailing Address - City:ROSCOE
Mailing Address - State:IL
Mailing Address - Zip Code:61073-7420
Mailing Address - Country:US
Mailing Address - Phone:779-696-9000
Mailing Address - Fax:
Practice Address - Street 1:4282 E ROCKTON RD
Practice Address - Street 2:
Practice Address - City:ROSCOE
Practice Address - State:IL
Practice Address - Zip Code:61073-7420
Practice Address - Country:US
Practice Address - Phone:779-696-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209025577363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics