Provider Demographics
NPI:1689206484
Name:HENRY, ALAJAH M (CNA)
Entity Type:Individual
Prefix:
First Name:ALAJAH
Middle Name:M
Last Name:HENRY
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 E COZZA DR
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-6514
Mailing Address - Country:US
Mailing Address - Phone:509-325-6800
Mailing Address - Fax:
Practice Address - Street 1:44 E COZZA DR
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-6514
Practice Address - Country:US
Practice Address - Phone:509-325-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANC60621562376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2077844Medicaid