Provider Demographics
NPI:1497830822
Name:HENSLEY, MICHELE IMOGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:IMOGENE
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 GREENWAY AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27608-1308
Mailing Address - Country:US
Mailing Address - Phone:919-789-9800
Mailing Address - Fax:
Practice Address - Street 1:1125 CARTHAGE ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4162
Practice Address - Country:US
Practice Address - Phone:919-774-6023
Practice Address - Fax:919-776-6359
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500094207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCG29909Medicare UPIN