Provider Demographics
NPI:1669946554
Name:HENSLEY, JEAN E (NP)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:E
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:JEAN
Other - Middle Name:E
Other - Last Name:HENSLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:11138 DEL AMO BLVD STE 329
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90715-1103
Mailing Address - Country:US
Mailing Address - Phone:248-721-6527
Mailing Address - Fax:714-948-5912
Practice Address - Street 1:4154 CHARLENE DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-1553
Practice Address - Country:US
Practice Address - Phone:248-721-6527
Practice Address - Fax:714-948-5912
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010762363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care