Provider Demographics
NPI:1669774188
Name:HENNION, CAROLYN (LPN)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:
Last Name:HENNION
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 53
Mailing Address - Street 2:
Mailing Address - City:LONG POND
Mailing Address - State:PA
Mailing Address - Zip Code:18334-0053
Mailing Address - Country:US
Mailing Address - Phone:570-643-2774
Mailing Address - Fax:
Practice Address - Street 1:2250 HICKORY RD
Practice Address - Street 2:SUITE 240
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1047
Practice Address - Country:US
Practice Address - Phone:570-454-5031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-04
Last Update Date:2010-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN274076251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care