Provider Demographics
NPI:1073795431
Name:HENRY, PATRICIA (RN)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 196
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08848-0196
Mailing Address - Country:US
Mailing Address - Phone:908-995-9471
Mailing Address - Fax:
Practice Address - Street 1:151 KNOLLCROFT RD
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:NJ
Practice Address - Zip Code:07939-5001
Practice Address - Country:US
Practice Address - Phone:908-647-0180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO06533600163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse