Provider Demographics
NPI:1457152852
Name:HENAWI, ELIZABETH JANELLE (BLS,)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JANELLE
Last Name:HENAWI
Suffix:
Gender:
Credentials:BLS,
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:JANELLE
Other - Last Name:WIEDEMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14015 N 94TH ST APT 1123
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3728
Mailing Address - Country:US
Mailing Address - Phone:940-859-1395
Mailing Address - Fax:
Practice Address - Street 1:14015 N 94TH ST APT 1123
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-3728
Practice Address - Country:US
Practice Address - Phone:940-859-1395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer