Provider Demographics
NPI:1780392837
Name:HENRIQUEZ, ADALIS (RN)
Entity type:Individual
Prefix:
First Name:ADALIS
Middle Name:
Last Name:HENRIQUEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 STANIFORD ST APT 202
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2526
Mailing Address - Country:US
Mailing Address - Phone:617-792-2069
Mailing Address - Fax:
Practice Address - Street 1:150 STANIFORD ST APT 202
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2526
Practice Address - Country:US
Practice Address - Phone:617-792-2069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2262594163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health