Provider Demographics
NPI:1710239686
Name:HENRY, RAFIE JEAN (LVN)
Entity Type:Individual
Prefix:MRS
First Name:RAFIE
Middle Name:JEAN
Last Name:HENRY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11403 MIDDLEBURGH DR
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-8612
Mailing Address - Country:US
Mailing Address - Phone:281-376-6406
Mailing Address - Fax:
Practice Address - Street 1:11403 MIDDLEBURGH DR
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377-8612
Practice Address - Country:US
Practice Address - Phone:281-376-6406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85453164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse