Provider Demographics
NPI:1790298487
Name:HENNER, ANNE KATHRYN (MSN, AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:KATHRYN
Last Name:HENNER
Suffix:
Gender:F
Credentials:MSN, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 CHESTNUT ST STE 420A
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4247
Mailing Address - Country:US
Mailing Address - Phone:267-250-3813
Mailing Address - Fax:
Practice Address - Street 1:925 CHESTNUT ST STE 420A
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4247
Practice Address - Country:US
Practice Address - Phone:215-955-8874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN574253363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health