Provider Demographics
NPI:1396434460
Name:HENNIGAR, JACQUELINE MARIE (APRN)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MARIE
Last Name:HENNIGAR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:MARIE
Other - Last Name:WOYNAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:79 WAWECUS ST STE 103
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2173
Mailing Address - Country:US
Mailing Address - Phone:860-886-1862
Mailing Address - Fax:860-886-2046
Practice Address - Street 1:79 WAWECUS ST STE 103
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2173
Practice Address - Country:US
Practice Address - Phone:860-886-1862
Practice Address - Fax:860-886-2046
Is Sole Proprietor?:No
Enumeration Date:2023-05-04
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11895363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily