Provider Demographics
NPI:1912170424
Name:HENSLEY, MARTHA MAE (CRNA)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:MAE
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 435
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON GAP
Mailing Address - State:VA
Mailing Address - Zip Code:24277-9645
Mailing Address - Country:US
Mailing Address - Phone:276-546-1027
Mailing Address - Fax:
Practice Address - Street 1:1990 HOLTON AVE. EAST
Practice Address - Street 2:
Practice Address - City:BIG STONE GAP
Practice Address - State:VA
Practice Address - Zip Code:24219
Practice Address - Country:US
Practice Address - Phone:276-523-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-04
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001106926367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAMC10053Medicare PIN