Provider Demographics
NPI:1831274828
Name:HENNENHOEFER, AMBER R (DO)
Entity type:Individual
Prefix:DR
First Name:AMBER
Middle Name:R
Last Name:HENNENHOEFER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:AMBER
Other - Middle Name:RAE
Other - Last Name:WENSEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:9913 N 95TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4586
Mailing Address - Country:US
Mailing Address - Phone:480-860-8998
Mailing Address - Fax:480-377-9245
Practice Address - Street 1:9913 N 95TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4586
Practice Address - Country:US
Practice Address - Phone:480-860-8998
Practice Address - Fax:480-377-9245
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5023208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3Z3943OtherHEALTHNET
AZ333821Medicaid
AZZ136763Medicare PIN
AZ333821Medicaid
AZ3Z3943OtherHEALTHNET