Provider Demographics
NPI:1376326991
Name:HENRY, JOAN CLAUDINE
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:CLAUDINE
Last Name:HENRY
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 1:3100 TERWOOD RD APT J96
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1419
Mailing Address - Country:US
Mailing Address - Phone:215-902-6640
Mailing Address - Fax:
Practice Address - Street 1:3100 TERWOOD RD APT J96
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1419
Practice Address - Country:US
Practice Address - Phone:215-902-6640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0013492153374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty