Provider Demographics
NPI:1013277078
Name:HENSON, JOSEPH WALTER (FNP)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:WALTER
Last Name:HENSON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 E 106TH ST
Mailing Address - Street 2:5E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-4058
Mailing Address - Country:US
Mailing Address - Phone:347-271-0812
Mailing Address - Fax:
Practice Address - Street 1:236 E 106TH ST
Practice Address - Street 2:5E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-4058
Practice Address - Country:US
Practice Address - Phone:347-271-0812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF337162-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily