Provider Demographics
NPI:1518442300
Name:HENRY, CARLA RENEE (RN)
Entity Type:Individual
Prefix:MS
First Name:CARLA
Middle Name:RENEE
Last Name:HENRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:CARLA
Other - Middle Name:RENEE
Other - Last Name:STREIB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:349 SOUTH MAIN ST.
Mailing Address - Street 2:COMMUNITY BLOOD CENTER/COMMUNITY TISSUE SERVICES
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-2715
Mailing Address - Country:US
Mailing Address - Phone:937-461-3450
Mailing Address - Fax:937-461-9584
Practice Address - Street 1:349 SOUTH MAIN ST.
Practice Address - Street 2:COMMUNITY BLOOD CENTER/COMMUNITY TISSUE SERVICES
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-2715
Practice Address - Country:US
Practice Address - Phone:937-461-3450
Practice Address - Fax:937-461-9584
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH259583163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN259583OtherRN