Provider Demographics
NPI:1134824618
Name:HENRY, BIANCA
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43313 WOODWARD AVE # 1343
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5007
Mailing Address - Country:US
Mailing Address - Phone:248-759-0100
Mailing Address - Fax:
Practice Address - Street 1:51 STEGMAN LN
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48340-1662
Practice Address - Country:US
Practice Address - Phone:248-759-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health