Individual provider · Type 1 NPI
Jesse Lee Henneberg, APN
Neonatal Nurse Practitioner · Peoria, IL
NPI number
1316299456
Active
Practice location
530 NE Glen Oak Ave
Peoria, IL 61637-0001
Mailing address
201 E Madison St Ste 328
Springfield, IL 62702-5131
Other practice locations
- 415 N 9th St Ste 4W16, Springfield, IL 62702-5303 · (217) 545-8000
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Critical Care Neonatal Nurse Practitioner | 363LN0005X | 209009916 (IL) |
| Neonatal Nurse Practitioner Primary | 363LN0000X | 209009916 (IL) |
Neonatal Nurse Practitioner: Definition to come...
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About NPI 1316299456
Jesse Lee Henneberg, APN's National Provider Identifier is 1316299456, issued on Oct 14, 2012. The primary taxonomy on file is Neonatal Nurse Practitioner (363LN0000X), and the practice location is in Peoria, IL. The record was last updated on Jul 19, 2021.