Provider Demographics
NPI:1689187460
Name:HENRY, BARBARA ANNETTE
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANNETTE
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 1:215 OUTER BELLE RD APT A
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45426-1535
Mailing Address - Country:US
Mailing Address - Phone:937-520-3904
Mailing Address - Fax:
Practice Address - Street 1:215 OUTER BELLE RD APT A
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45426-1535
Practice Address - Country:US
Practice Address - Phone:937-520-3904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH143497M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse