Provider Demographics
NPI:1275872665
Name:HENN, KRISTEN RAE
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:RAE
Last Name:HENN
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 1:5043 TRI COUNTY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-9358
Mailing Address - Country:US
Mailing Address - Phone:513-382-7980
Mailing Address - Fax:
Practice Address - Street 1:5043 TRI COUNTY VIEW DR
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-9358
Practice Address - Country:US
Practice Address - Phone:513-382-7980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH151594164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse