Provider Demographics
NPI:1861650434
Name:HENRY, MARIE DONNA (FNP)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:DONNA
Last Name:HENRY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 ISELIN AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-2915
Mailing Address - Country:US
Mailing Address - Phone:718-549-6700
Mailing Address - Fax:718-796-0758
Practice Address - Street 1:5050 ISELIN AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-2915
Practice Address - Country:US
Practice Address - Phone:718-549-6700
Practice Address - Fax:718-796-0758
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332945-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily