Provider Demographics
NPI:1669100731
Name:HENNINGER, LAURA ANN (RN, CDCES)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANN
Last Name:HENNINGER
Suffix:
Gender:F
Credentials:RN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 E 3900 S STE 390
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1256
Mailing Address - Country:US
Mailing Address - Phone:801-743-4700
Mailing Address - Fax:
Practice Address - Street 1:1140 E 3900 S STE 390
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1256
Practice Address - Country:US
Practice Address - Phone:801-743-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT21700638163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator