Provider Demographics
NPI:1629372305
Name:HENRY, LEAH B (APN)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:B
Last Name:HENRY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:B
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 230181
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89105-0181
Mailing Address - Country:US
Mailing Address - Phone:702-837-1265
Mailing Address - Fax:702-837-1706
Practice Address - Street 1:12300 LAS VEGAS BLVD S
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89044-9506
Practice Address - Country:US
Practice Address - Phone:702-837-1265
Practice Address - Fax:702-837-1706
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN001230363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care