Provider Demographics
NPI:1801800818
Name:HENNIG, ARNELLA C (MD)
Entity type:Individual
Prefix:
First Name:ARNELLA
Middle Name:C
Last Name:HENNIG
Suffix:
Gender:F
Credentials:MD
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 391
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97308-0391
Mailing Address - Country:US
Mailing Address - Phone:503-561-5135
Mailing Address - Fax:
Practice Address - Street 1:875 OAK ST SE
Practice Address - Street 2:SUITE 1080
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3975
Practice Address - Country:US
Practice Address - Phone:503-561-5294
Practice Address - Fax:503-561-4789
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD174292085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR037916Medicaid
ORR00WCGHFEMedicare PIN
E88036Medicare UPIN
OR037916Medicaid