Provider Demographics
NPI:1447097282
Name:HENNINGER, ELI ROBERT (PA-C)
Entity type:Individual
Prefix:
First Name:ELI
Middle Name:ROBERT
Last Name:HENNINGER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2391 E VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:LOGANTON
Mailing Address - State:PA
Mailing Address - Zip Code:17747-9379
Mailing Address - Country:US
Mailing Address - Phone:570-502-4133
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9350
Practice Address - Country:US
Practice Address - Phone:570-502-4133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA065670363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant