Provider Demographics
NPI:1144275637
Name:HENNING, BRIAN (CFNP)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:HENNING
Suffix:
Gender:M
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1927 N FOWLER ST
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-3330
Mailing Address - Country:US
Mailing Address - Phone:505-391-8108
Mailing Address - Fax:505-397-0836
Practice Address - Street 1:515 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-8119
Practice Address - Country:US
Practice Address - Phone:505-397-0560
Practice Address - Fax:505-397-0836
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR42824363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM26-927Medicaid
NMS58996Medicare UPIN