MARISSA AMBER VAN HENNIK PA NPI 1740213727

NPI Information

NPI: 1740213727
Provider Name: MARISSA AMBER VAN HENNIK, PA
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

Organization: PROHEALTH PHYSICIANS PC

PECOS Registration: Yes

Address:
56 FRANKLIN ST
WATERBURY, CT
ZIP 06706
Phone: (203) 709-6004
Get Directions

Marissa Amber Van Hennik, PA is a medical physician assistant in Waterbury, CT with 22 years of experience. Marissa Amber Van Hennik, PA NPI is 1740213727. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

56 FRANKLIN ST
WATERBURY, CT
ZIP 06706-221
Phone: (203) 709-6004
Fax: (203) 709-3700

The NPI 1740213727 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/10/2006 and was last updated on 9/12/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AM0700X	Physician Assistant	Medical	001324	CONNECTICUT	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	P83788	MEDICARE UPIN	CONNECTICUT

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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