| NPI | 1104903061 |
|---|---|
| Former Name | TAMMY JO HENNING |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 4577-33) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209-003115) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2011-10-20 |