Mark Hennecken, LPN
Individual provider Active NPI Licensed Practical Nurse · Milton, WA
NPI 1811536717 · NPPES record last updated Sep 19, 2024
Key facts
- NPI
- 1811536717
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- 60984646 (WA)
- Practice address
- 7224 Pacific Hwy E.
Milton, WA 98354 - Phone
- (253) 220-6183
- NPI assigned
- Dec 26, 2019
- Reactivated
- Sep 19, 2024
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60984646 | WA | MD | Licensed Practical Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 60984646 | WA | Yes |
Addresses
Primary practice location
7224 Pacific Hwy E.
Milton, WA 98354
Mailing address
8117 70TH Ave SW
Lakewood, WA 98499-2009
Phone (720) 339-3306
Other providers in Milton, WA
- Stephen Haggard
- Haggarddpm Home Foot Care LLC
- Brandy Rae Harteau
- John Heckel
- Michelle Heinrich
- David Hensley
- Sungil Ho
- Ha T Hoang
- Sierra Hodge-Finch
- Shanta Rene Horton
All providers in Milton, WA · Licensed Practical Nurse in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 19, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.