Provider Demographics
NPI:1427416031
Name:HENISE, AMELIA
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:HENISE
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 1:2700 NW 63RD ST
Mailing Address - Street 2:APT 30
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-4810
Mailing Address - Country:US
Mailing Address - Phone:717-887-3311
Mailing Address - Fax:405-225-7326
Practice Address - Street 1:2700 NW 63RD ST
Practice Address - Street 2:APT 30
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-4810
Practice Address - Country:US
Practice Address - Phone:717-887-3311
Practice Address - Fax:405-225-7326
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management