Provider Demographics
NPI:1124368436
Name:HENRY, CIARA MONEE (LPN)
Entity Type:Individual
Prefix:MS
First Name:CIARA
Middle Name:MONEE
Last Name:HENRY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1962 7TH AVE APT 5A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-1750
Mailing Address - Country:US
Mailing Address - Phone:212-663-7972
Mailing Address - Fax:
Practice Address - Street 1:1962 7TH AVE APT 5A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-1750
Practice Address - Country:US
Practice Address - Phone:212-663-7972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY312308-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse