Basic Information
| Provider Information | |||||||||
| NPI: | 1518373174 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HENNESSEY -BROWN | ||||||||
| FirstName: | SEANNE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | X | ||||||||
| Credential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 4425 OLD RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145899363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154833217 | ||||||||
| FaxNumber: | 3155894893 | ||||||||
| Practice Location | |||||||||
| Address1: | 4425 OLD RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145899363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154833217 | ||||||||
| FaxNumber: | 3155894893 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2014 | ||||||||
| LastUpdateDate: | 07/03/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP2201X | 345026 | NY | Y | Nursing Service Providers | Registered Nurse | Ambulatory Care |
ID Information
| ID | Type | State | Issuer | Description | N/A | 01 | NONE | OTHER |