Provider Demographics
NPI:1689138323
Name:HENRY, POLLI ANN
Entity Type:Individual
Prefix:MRS
First Name:POLLI
Middle Name:ANN
Last Name:HENRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2671 W US HIGHWAY 22 LOT 1
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-7659
Mailing Address - Country:US
Mailing Address - Phone:740-606-0698
Mailing Address - Fax:
Practice Address - Street 1:2671 W US HIGHWAY 22 LOT 1
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-7659
Practice Address - Country:US
Practice Address - Phone:740-606-0698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health