Provider Demographics
NPI:1760945000
Name:HENRY, PATRICIA ANN (RN)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANN
Last Name:HENRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:HUNT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:123 SHERATON ROAD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE, ONONDAGA
Mailing Address - State:NY
Mailing Address - Zip Code:13219
Mailing Address - Country:US
Mailing Address - Phone:315-491-4785
Mailing Address - Fax:
Practice Address - Street 1:4900 BROAD ROAD
Practice Address - Street 2:4V
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215
Practice Address - Country:US
Practice Address - Phone:315-492-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY324989-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse