Provider Demographics
NPI:1841566965
Name:HENRY, TRESKA (LPN)
Entity Type:Individual
Prefix:
First Name:TRESKA
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 SAINT PAULS PL APT D9
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-1609
Mailing Address - Country:US
Mailing Address - Phone:609-724-8378
Mailing Address - Fax:
Practice Address - Street 1:36 DEKALB AVE
Practice Address - Street 2:
Practice Address - City:BROOKYN
Practice Address - State:NY
Practice Address - Zip Code:11203
Practice Address - Country:US
Practice Address - Phone:347-563-4780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-23
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY80073601163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse