Provider Demographics
NPI:1629116108
Name:HENLEY, MARY FISHER (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:FISHER
Last Name:HENLEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 E INNES ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28146-6030
Mailing Address - Country:US
Mailing Address - Phone:704-216-8834
Mailing Address - Fax:704-638-3129
Practice Address - Street 1:1811 E INNES ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28146-6030
Practice Address - Country:US
Practice Address - Phone:704-216-8834
Practice Address - Fax:704-638-3129
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5002409363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7005023Medicaid
NC2593214OtherMEDICARE PTAN INDIVIDUAL