Provider Demographics
NPI:1700330842
Name:HENSON, EDWARD (APRN)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:HENSON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4404 CARRIER DOVE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-2661
Mailing Address - Country:US
Mailing Address - Phone:702-882-5448
Mailing Address - Fax:
Practice Address - Street 1:530 LYTTON AVE FL 2
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-1541
Practice Address - Country:US
Practice Address - Phone:415-663-5584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002229363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner