Provider Demographics
NPI:1629601364
Name:HENRISH, MADDIE (NP)
Entity Type:Individual
Prefix:
First Name:MADDIE
Middle Name:
Last Name:HENRISH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 CARRIAGE HOUSE DR
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:NC
Mailing Address - Zip Code:27235-9420
Mailing Address - Country:US
Mailing Address - Phone:724-678-1090
Mailing Address - Fax:
Practice Address - Street 1:1212 CARRIAGE HOUSE DR
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:NC
Practice Address - Zip Code:27235-9420
Practice Address - Country:US
Practice Address - Phone:724-678-1090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF02200071363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily