Provider Demographics
NPI:1619327608
Name:HENRIQUES, ENNIQUE
Entity Type:Individual
Prefix:
First Name:ENNIQUE
Middle Name:
Last Name:HENRIQUES
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 1:105 ARDELL RD
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-6509
Mailing Address - Country:US
Mailing Address - Phone:347-313-4664
Mailing Address - Fax:
Practice Address - Street 1:105 ARDELL RD
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-6509
Practice Address - Country:US
Practice Address - Phone:347-313-4664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY322003164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse