Provider Demographics
NPI:1649275710
Name:HENZLER, MARTHA CLAIRE K (PA-C)
Entity type:Individual
Prefix:
First Name:MARTHA CLAIRE
Middle Name:K
Last Name:HENZLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 BROAD ST
Mailing Address - Street 2:STE B
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-2948
Mailing Address - Country:US
Mailing Address - Phone:336-993-2224
Mailing Address - Fax:336-993-0382
Practice Address - Street 1:280 BROAD ST
Practice Address - Street 2:STE B
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-2948
Practice Address - Country:US
Practice Address - Phone:336-993-2224
Practice Address - Fax:336-993-0382
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100847363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S70595Medicare UPIN
2742520EMedicare ID - Type Unspecified