Provider Demographics
NPI:1508007147
Name:HENRY, PAULA M (NP)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:M
Last Name:HENRY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9498 SHADY BND
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-9220
Mailing Address - Country:US
Mailing Address - Phone:317-750-5382
Mailing Address - Fax:
Practice Address - Street 1:1450 E 20TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46218-3454
Practice Address - Country:US
Practice Address - Phone:317-653-1990
Practice Address - Fax:176-531-9993
Is Sole Proprietor?:No
Enumeration Date:2009-03-11
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002862363LF0000X
IN28099990A163W00000X
IN71002862A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine