Provider Demographics
NPI:1578501961
Name:HENAULT, KAREN (APRN)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:HENAULT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06118-1823
Mailing Address - Country:US
Mailing Address - Phone:860-569-5900
Mailing Address - Fax:860-569-5905
Practice Address - Street 1:281 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06118-1823
Practice Address - Country:US
Practice Address - Phone:860-569-5900
Practice Address - Fax:860-569-5905
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001595363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004050993Medicaid
C01369Medicare Oscar/Certification