| NPI | 1912372061 |
|---|---|
| Former Name | MARY L. HENNINGSGAARD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA56986) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA PA56986) |
| Enumeration Date | 2015-12-01 |
| Last Update Date | 2022-12-05 |