Provider Demographics
NPI:1275826653
Name:HENRY, LYNETTE (LPN)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:
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 1:5993 TOWNSEND ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48213-2472
Mailing Address - Country:US
Mailing Address - Phone:313-285-4823
Mailing Address - Fax:
Practice Address - Street 1:32500 CONCORD DR STE 343
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1119
Practice Address - Country:US
Practice Address - Phone:248-588-0512
Practice Address - Fax:586-620-6040
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703105630164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse