Henneberg, Jesse Lee

Henneberg, Jesse Lee is an sole proprietor health care provider with primary practice located at 530 Ne Glen Oak Ave , Peoria IL 61637-0001. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Neonatal, Critical Care, Physician Assistants & Advanced Practice Nursing Providers / Neonatal. Physician Assistants & Advanced Practice Nursing Providers / Neonatal is his primary health care specialty. Henneberg, Jesse Lee can be contacted via phone (309) 624-0629.

Contact Information

Primary practice address
530 Ne Glen Oak Ave Peoria IL 61637-0001
Phone: (309) 624-0629
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Neonatal, Critical Care 363LN0005X 209009916 Illinois
Physician Assistants & Advanced Practice Nursing Providers / Neonatal 363LN0000X 209009916 Illinois

Profile Details

NPI number 1316299456
LBN Legal business name Henneberg, Jesse Lee
Credentials Advanced Practice Nurse (APN)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 14th, 2012
Last updated Jul 19th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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