Provider Demographics
NPI:1457313405
Name:HENN, THERESE A (NP)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:A
Last Name:HENN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7026 N VILLAGE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-2461
Mailing Address - Country:US
Mailing Address - Phone:520-241-6944
Mailing Address - Fax:520-329-8625
Practice Address - Street 1:7091 E SPEEDWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1241
Practice Address - Country:US
Practice Address - Phone:520-241-6944
Practice Address - Fax:520-806-7225
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN043596363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ760646Medicaid
AZS51003Medicare UPIN
AZ107804Medicare ID - Type Unspecified