Provider Demographics
NPI:1366016495
Name:HENNINGER, RACHAEL ALINE (PA-C)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:ALINE
Last Name:HENNINGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:ALINE
Other - Last Name:PAPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:67 S HIGLEY RD STE 103
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-1167
Mailing Address - Country:US
Mailing Address - Phone:602-633-4334
Mailing Address - Fax:
Practice Address - Street 1:5590 W CHANDLER BLVD STE 3
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-3744
Practice Address - Country:US
Practice Address - Phone:602-633-4334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9320363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant