Provider Demographics
NPI:1184469504
Name:HENNINGS, ALANA ROSE
Entity type:Individual
Prefix:
First Name:ALANA
Middle Name:ROSE
Last Name:HENNINGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALANA
Other - Middle Name:ROSE
Other - Last Name:NOVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:801 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:TILLAMOOK
Mailing Address - State:OR
Mailing Address - Zip Code:97141-3926
Mailing Address - Country:US
Mailing Address - Phone:503-842-3900
Mailing Address - Fax:503-842-3901
Practice Address - Street 1:801 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:TILLAMOOK
Practice Address - State:OR
Practice Address - Zip Code:97141-3926
Practice Address - Country:US
Practice Address - Phone:503-842-3900
Practice Address - Fax:503-842-3901
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR111332172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker