ROY RANDEL HENNEBERG (NPI# 1114956216) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114956216 |
| Entity Type | Individual |
| Full Name | ROY RANDEL HENNEBERG |
| Credential | MD |
| Practice Address |
980 W Ironwood Dr Suite 304 Coeur D Alene ID 83814 |
| Mailing Address |
980 W Ironwood Dr Ste 201 Coeur D Alene ID 83814-2668 |
| Practice Telephone | 2087654888 |
| Practice Fax Number | 2086678618 |
| Mailing Telephone | 2087654888 |
| Mailing Fax Number | 2086678618 |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2020-05-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | M4722 | ID | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 001684500 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 980 W Ironwood Dr Ste 201, Coeur D Alene, ID 838142668 | 2087654888 | 2086678618 |
| Street Address |
980 W IRONWOOD DR SUITE 304 |
| City | COEUR D ALENE |
| State | ID |
| Zip Code | 83814 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477552008 | Jean Marie Prince | Pediatrics | 980 W Ironwood Dr, Ste 302, Coeur D Alene, ID 83814-2604 | 2005-07-15 |
| 1538619630 | Breanne Huss | Advanced Practice Midwife | 980 W Ironwood Dr, Ste 306, Coeur D Alene, ID 83814-2668 | 2016-10-12 |
| 1760708044 | Faith Marie Krull | Midwife | 980 W Ironwood Dr, Suite 306, Coeur D Alene, ID 83814-2668 | 2010-04-13 |
| 1417270158 | Christy L Riley | Pediatrics | 980 W Ironwood Dr, Suite 302, Coeur D Alene, ID 83814-2668 | 2010-03-09 |
| 1114161551 | Marston T Westbrook, Dds, LLC | Dentist | 980 W Ironwood Dr, Suite 301, Coeur D Alene, ID 83814-2668 | 2009-04-29 |
| 1619110822 | Kevin Jay Schultz | Obstetrics & Gynecology | 980 W Ironwood Dr, Suite 304, Coeur D Alene, ID 83814-2668 | 2009-04-17 |
| 1851545628 | Kathyrn Ann Sumner Kelso | Counselor | 980 W Ironwood Dr, Suite 101, Coeur D Alene, ID 83814-2668 | 2008-11-06 |
| 1609029826 | Julie M. Meltzer | Obstetrics & Gynecology | 980 W Ironwood Dr, 306, Coeur D Alene, ID 83814-2668 | 2008-10-31 |
| 1518123660 | Katie Renee' Knapp | Massage Therapist | 980 W Ironwood Dr, Ste 101, Coeur D Alene, ID 83814-2668 | 2008-07-29 |
| 1255509410 | Apple Family Care Pllc | Family Medicine | 980 W Ironwood Dr, Suite 201, Coeur D Alene, ID 83814-2668 | 2008-02-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477162675 | Dehra Mcfaddan | Social Worker | 211 E. Coeur D'alene Ave, 102, Coeur D Alene, ID 83814 | 2020-07-24 |
| 1043838634 | Yendi Labelle | Nurse Practitioner | 1115 N Ironwood Drive, Coeur D'alene, ID 83814 | 2020-07-09 |
| 1295353217 | Cultivation, LLC | Counselor | 211 E. Coeur Dalene Ave. Ste 102, Coeur D'alene, ID 83814 | 2020-07-07 |
| 1306487517 | Northwest Integrated Health, LLP | Clinic/Center | 1250 West N. Northwood Center Ct, Suite B, Coeur D'alene, ID 83814 | 2019-09-30 |
| 1730740465 | Connor Williams | Physical Therapist | 1812 W Lakewood Dr, Ste. 100, Coeur D Alene, ID 83814 | 2019-06-24 |
| 1912480153 | Nadine M Lewis | Social Worker | 211 E. Coeur D'alene Ave., Coeur D'alene, ID 83814 | 2018-09-13 |
| 1992208631 | Orthopedic Surgery and Sports | Orthopaedic Surgery | 1812 N Lakewood Drive, Suite 100, Coeur D'alene, ID 83814 | 2018-03-08 |
| 1346758042 | Heather Marie Johnson | Counselor | 7905 Meadowlark Way, Cda, ID 83814 | 2018-01-16 |
| 1881113413 | Brevity Treatment Services | Counselor | 2201 N. Government Way Ste. L, Coeur D'alene, ID 83814 | 2017-09-14 |
| 1366969628 | Jennifer La Gina Highfield | Massage Therapist | 1104 N Ste B, Coeur D Alene, ID 83814 | 2017-08-28 |
| Find all providers in zip 83814 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740249275 | Daryl K Maccarter | Specialist | 950 W Ironwood Dr, Coeur D Alene, ID 83814-2644 | 2006-03-22 |
| 1326034430 | Jonathan S King | Specialist | 850 W Ironwood Dr Ste 202, Coeur D Alene, ID 83814-4903 | 2005-09-23 |
| 1467448860 | Lloyd E. Witham | Specialist | 1107 W Ironwood Dr, Coeur D Alene, ID 83814-2604 | 2005-09-21 |
| 1174000566 | Timothy Wayne Cork | Specialist | 2201 Ironwood Pl, Coeur D Alene, ID 83814-2670 | 2018-07-27 |
| 1952772196 | Gayle Dohrman | Specialist | 2195 Ironwood Ct, Coeur D Alene, ID 83814-2628 | 2015-10-14 |
| 1740539725 | Gregory R. Keese, M.d., P.C. | Specialist | 1107 W Ironwood Dr, Coeur D Alene, ID 83814-2604 | 2012-09-05 |
| 1619278082 | Kala Marie Moore | Specialist | 852 W Kathleen Ave, Coeur D Alene, ID 83815-9405 | 2010-11-16 |
| 1700107612 | Jill Peterson | Specialist | 6125 N Sunshine St, Coeur D Alene, ID 83815 | 2010-06-15 |
| 1003050527 | Peter C Jones Md Pa | Specialist | 2121 W Ironwood Center Dr, Coeur D Alene, ID 83814-2639 | 2009-04-28 |
| 1013184837 | Maryanne Kleven | Specialist | 500 W Aqua Ave, Coeur D Alene, ID 83815-7764 | 2008-05-12 |
| Find all providers in COEUR D ALENE | ||||
| City | COEUR D ALENE |
| Zip Code | 83814 |
Please comment or provide details below to improve the information on ROY RANDEL HENNEBERG.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.