Provider Demographics
NPI:1669783346
Name:HENRY, DIANE (WHNP)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 W WHEATLAND RD STE A
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-4409
Mailing Address - Country:US
Mailing Address - Phone:972-709-0111
Mailing Address - Fax:972-709-0110
Practice Address - Street 1:3650 W WHEATLAND RD STE A
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-4409
Practice Address - Country:US
Practice Address - Phone:972-709-0111
Practice Address - Fax:972-709-0110
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX505845363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology