Provider Demographics
NPI:1295777670
Name:HENSEL, LANI S (CRNA)
Entity type:Individual
Prefix:
First Name:LANI
Middle Name:S
Last Name:HENSEL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7240 MACKENZIE LN
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-4414
Mailing Address - Country:US
Mailing Address - Phone:269-321-9098
Mailing Address - Fax:
Practice Address - Street 1:7240 MACKENZIE LN
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-4414
Practice Address - Country:US
Practice Address - Phone:269-321-9098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704235648367500000X
MNR1440698367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI466882110Medicaid
MI466882110Medicaid
MNENROLLEDMedicaid
MI0M83200025Medicare ID - Type Unspecified
IAENROLLEDMedicaid