Provider Demographics
NPI:1659928901
Name:HENLEY, ROSEANN (B&B)
Entity Type:Individual
Prefix:
First Name:ROSEANN
Middle Name:
Last Name:HENLEY
Suffix:
Gender:F
Credentials:B&B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282 DYKEN DR
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-2684
Mailing Address - Country:US
Mailing Address - Phone:636-357-3993
Mailing Address - Fax:
Practice Address - Street 1:282 DYKEN DR
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-2684
Practice Address - Country:US
Practice Address - Phone:636-357-3993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider