Provider Demographics
NPI:1518373174
Name:HENNESSEY -BROWN, SEANNE X
Entity type:Individual
Prefix:
First Name:SEANNE
Middle Name:
Last Name:HENNESSEY -BROWN
Suffix:X
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 OLD RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:NY
Mailing Address - Zip Code:14589-9363
Mailing Address - Country:US
Mailing Address - Phone:315-483-3217
Mailing Address - Fax:315-589-4893
Practice Address - Street 1:4425 OLD RIDGE RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:NY
Practice Address - Zip Code:14589-9363
Practice Address - Country:US
Practice Address - Phone:315-483-3217
Practice Address - Fax:315-589-4893
Is Sole Proprietor?:No
Enumeration Date:2014-07-03
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345026163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
N/AOtherNONE