Provider Demographics
NPI:1124010350
Name:HENLEY, ANNE E (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:E
Last Name:HENLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:341 LOGAN ST
Mailing Address - Street 2:STE 100
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-1557
Mailing Address - Country:US
Mailing Address - Phone:317-773-5555
Mailing Address - Fax:317-773-6200
Practice Address - Street 1:341 LOGAN ST
Practice Address - Street 2:STE 100
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-1557
Practice Address - Country:US
Practice Address - Phone:317-773-5555
Practice Address - Fax:317-773-6200
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01032800A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1000870408Medicaid
INM400071722Medicare PIN
IN160450022Medicare PIN
IN069570Medicare ID - Type Unspecified
IN1000870408Medicaid