Provider Demographics
NPI:1669962379
Name:HENNIG, COURTNY MARIE
Entity type:Individual
Prefix:
First Name:COURTNY
Middle Name:MARIE
Last Name:HENNIG
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 1:239 JEFFERSON ST APT 9
Mailing Address - Street 2:
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-1158
Mailing Address - Country:US
Mailing Address - Phone:567-201-5174
Mailing Address - Fax:
Practice Address - Street 1:239 JEFFERSON ST APT 9
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-1158
Practice Address - Country:US
Practice Address - Phone:567-201-5174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty