Provider Demographics
NPI:1659311058
Name:HENSON, LOIS L (DO)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:L
Last Name:HENSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E NATIONAL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-2100
Mailing Address - Country:US
Mailing Address - Phone:937-531-0113
Mailing Address - Fax:937-531-0123
Practice Address - Street 1:1 E NATIONAL RD STE 100
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-2100
Practice Address - Country:US
Practice Address - Phone:937-531-0113
Practice Address - Fax:937-531-0123
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.002846207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0404771Medicaid
OH0469796Medicare PIN
OH0404771Medicaid
OH0469798Medicare PIN
OHHE0469796Medicare PIN