Provider Demographics
NPI:1114671070
Name:HENSON, HENRIETTA LOUISE
Entity Type:Individual
Prefix:
First Name:HENRIETTA
Middle Name:LOUISE
Last Name:HENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:838 E HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-5942
Mailing Address - Country:US
Mailing Address - Phone:217-504-6658
Mailing Address - Fax:
Practice Address - Street 1:838 E HARRISON ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-5942
Practice Address - Country:US
Practice Address - Phone:217-504-6658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider