Provider Demographics
NPI:1154857431
Name:HENRY, EMILY NICOLE (LPN)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:NICOLE
Last Name:HENRY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:NICOLE
Other - Last Name:BENDELEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:5500 E 38TH CT APT 2
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-4330
Mailing Address - Country:US
Mailing Address - Phone:443-786-3735
Mailing Address - Fax:
Practice Address - Street 1:5500 E 38TH CT APT 2
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-4330
Practice Address - Country:US
Practice Address - Phone:443-786-3735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-05
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK122276164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse