Provider Demographics
NPI:1821281692
Name:HENNING, MICHAEL RICHARD (ANP-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:RICHARD
Last Name:HENNING
Suffix:
Gender:M
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11901 REEDY BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23838-4235
Mailing Address - Country:US
Mailing Address - Phone:804-896-1499
Mailing Address - Fax:804-590-1872
Practice Address - Street 1:11901 REEDY BRANCH RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23838-4235
Practice Address - Country:US
Practice Address - Phone:804-896-1499
Practice Address - Fax:804-590-1872
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167468363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2014219829Medicaid