Provider Demographics
NPI:1255768610
Name:HENSCHEN, HEIDI J (CRNA)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:J
Last Name:HENSCHEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:J
Other - Last Name:WAMMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1 SEAGATE 800
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:567-585-1945
Mailing Address - Fax:419-824-7359
Practice Address - Street 1:2142 N COVE BLVD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3895
Practice Address - Country:US
Practice Address - Phone:419-824-7315
Practice Address - Fax:419-824-7359
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.312237367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered