Provider Demographics
NPI:1861449134
Name:HENRY, BARBARA JAYNE (ANP, APNP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JAYNE
Last Name:HENRY
Suffix:
Gender:F
Credentials:ANP, APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8762 WOODBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53129-1086
Mailing Address - Country:US
Mailing Address - Phone:414-427-3557
Mailing Address - Fax:
Practice Address - Street 1:830 N 109TH ST
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-3754
Practice Address - Country:US
Practice Address - Phone:414-777-1811
Practice Address - Fax:414-777-1812
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI85494-030363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43950800Medicaid
WI43950800Medicaid
WI000368925Medicare ID - Type Unspecified