Provider Demographics
NPI:1093313967
Name:SEMPLE, HENRY CHARLES JR (LPN)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:CHARLES
Last Name:SEMPLE
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 96TH AVE NE UNIT D202
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-7904
Mailing Address - Country:US
Mailing Address - Phone:425-750-9089
Mailing Address - Fax:
Practice Address - Street 1:9930 EVERGREEN WAY STE Z150
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-3889
Practice Address - Country:US
Practice Address - Phone:425-347-5121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00042960164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse