Provider Demographics
NPI:1578044640
Name:TEMPLIN, HENRIETTE MICHAELA
Entity Type:Individual
Prefix:
First Name:HENRIETTE
Middle Name:MICHAELA
Last Name:TEMPLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-4744
Mailing Address - Country:US
Mailing Address - Phone:516-425-2052
Mailing Address - Fax:
Practice Address - Street 1:1023 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-4744
Practice Address - Country:US
Practice Address - Phone:516-425-2052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY357182163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse