Provider Demographics
NPI:1659612356
Name:HENSON, MINERVA (L AC, EAMP)
Entity Type:Individual
Prefix:
First Name:MINERVA
Middle Name:
Last Name:HENSON
Suffix:
Gender:F
Credentials:L AC, EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17924 140TH AVE NE STE 204
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-4315
Mailing Address - Country:US
Mailing Address - Phone:425-466-3505
Mailing Address - Fax:425-491-7333
Practice Address - Street 1:17924 140TH AVE NE STE 204
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-4315
Practice Address - Country:US
Practice Address - Phone:425-466-3505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-06
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60324955171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist