Provider Demographics
NPI:1790264828
Name:HENLEY, ELIZA JOAN (NP)
Entity Type:Individual
Prefix:
First Name:ELIZA
Middle Name:JOAN
Last Name:HENLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:27 CONGRESS ST STE 513
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-5523
Mailing Address - Country:US
Mailing Address - Phone:978-744-8388
Mailing Address - Fax:
Practice Address - Street 1:47 CONGRESS STREET
Practice Address - Street 2:SALEM FAMILY HEALTH CENTER
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970
Practice Address - Country:US
Practice Address - Phone:978-744-8388
Practice Address - Fax:978-740-2339
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71008213A363LF0000X
MARN2306004363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300019434Medicaid