National Provider Identifier Database

JESSE L HENNEBERG, APN – NPI #1316299456
Neonatal


Contact Information

JESSE L HENNEBERG, APN
530 NE GLEN OAK AVE
PEORIA, IL61637-0001
Phone: 309-624-0629
Fax:
Website:
Specialty Taxonomy Code
* Neonatal 363LN0000X
Neonatal, Critical Care 363LN0005X

* Indicates primary specialty

NPI Profile & details for JESSE L HENNEBERG

NPI Number 1316299456
Credentials APN
Entity Individual
Enumeration date 10/14/2012
Last updated 07/19/2021 - About 5 years ago
Sole proprietor1 Yes
Identifiers
  • IL License #: 209009916
Hospital affiliation n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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