Provider Demographics
NPI:1881803823
Name:HENNESSY, KATRINA (RN, IBCLC, RLC)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:HENNESSY
Suffix:
Gender:F
Credentials:RN, IBCLC, RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 PARK ESSEX PL
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95136-2517
Mailing Address - Country:US
Mailing Address - Phone:408-629-4844
Mailing Address - Fax:
Practice Address - Street 1:76 PARK ESSEX PL
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95136-2517
Practice Address - Country:US
Practice Address - Phone:408-629-4844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA458808163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant