Provider Demographics
NPI:1619267978
Name:HENRY, NEKOLE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:NEKOLE
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1174 GENESEE PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14619-1457
Mailing Address - Country:US
Mailing Address - Phone:585-328-9636
Mailing Address - Fax:
Practice Address - Street 1:1174 GENESEE PARK BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14619-1457
Practice Address - Country:US
Practice Address - Phone:585-328-9636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY248256-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse