Provider Demographics
NPI:1437485596
Name:HENRY, NORVAL
Entity Type:Individual
Prefix:
First Name:NORVAL
Middle Name:
Last Name:HENRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NORVAL
Other - Middle Name:
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1077 WILBERFORCE CLIFTON RD
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-9409
Mailing Address - Country:US
Mailing Address - Phone:937-219-7961
Mailing Address - Fax:
Practice Address - Street 1:1077 WILBERFORCE CLIFTON RD
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-9409
Practice Address - Country:US
Practice Address - Phone:937-219-7961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-26
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor