Provider Demographics
NPI:1245761691
Name:HENNINGS, MAJESTY
Entity type:Individual
Prefix:
First Name:MAJESTY
Middle Name:
Last Name:HENNINGS
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 1:1580 PROSPECT ST
Mailing Address - Street 2:F3
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-7113
Mailing Address - Country:US
Mailing Address - Phone:440-453-3156
Mailing Address - Fax:
Practice Address - Street 1:1580 PROSPECT ST
Practice Address - Street 2:F3
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-7113
Practice Address - Country:US
Practice Address - Phone:440-453-3156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor