Provider Demographics
NPI:1609135540
Name:HENRY, ROSALEE SANDRA
Entity Type:Individual
Prefix:MISS
First Name:ROSALEE
Middle Name:SANDRA
Last Name:HENRY
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 1:4488 ASHLYN REBECCA DR
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-2751
Mailing Address - Country:US
Mailing Address - Phone:678-770-2313
Mailing Address - Fax:
Practice Address - Street 1:4488 ASHLYN REBECCA DR
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-2751
Practice Address - Country:US
Practice Address - Phone:678-770-2313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-13
Last Update Date:2012-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula