Provider Demographics
NPI:1568163756
Name:HENRY, NIKIA (LVN)
Entity Type:Individual
Prefix:
First Name:NIKIA
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 S GRANDEE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-4260
Mailing Address - Country:US
Mailing Address - Phone:323-812-8190
Mailing Address - Fax:
Practice Address - Street 1:933 S GRANDEE AVE APT 2
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-4260
Practice Address - Country:US
Practice Address - Phone:323-812-8190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA249004164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse