Provider Demographics
NPI:1568767523
Name:HENKELS, ANDREA MAURENE (LAC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MAURENE
Last Name:HENKELS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 ROUTE 343
Mailing Address - Street 2:
Mailing Address - City:MILLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:12545-6163
Mailing Address - Country:US
Mailing Address - Phone:845-797-7755
Mailing Address - Fax:
Practice Address - Street 1:80 ROUTE 343
Practice Address - Street 2:
Practice Address - City:MILLBROOK
Practice Address - State:NY
Practice Address - Zip Code:12545-6163
Practice Address - Country:US
Practice Address - Phone:845-797-7755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004116171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist