Provider Demographics
NPI:1891948154
Name:HENRY, DOROTHY (RN)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 N. ORCHARD HEIGHTS WAY
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-8344
Mailing Address - Country:US
Mailing Address - Phone:208-440-6771
Mailing Address - Fax:888-647-0695
Practice Address - Street 1:144 N. ORCHARD HEIGHTS WAY
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-8344
Practice Address - Country:US
Practice Address - Phone:208-440-6771
Practice Address - Fax:888-647-0695
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-27130163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDN-27130OtherNURSING LICENSE