Provider Demographics
NPI:1952617169
Name:HENZEY, DIANE ALANE (FNP)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:ALANE
Last Name:HENZEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13525 DULLES TECHNOLOGY DR
Mailing Address - Street 2:PO BOX 5143
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-3413
Mailing Address - Country:US
Mailing Address - Phone:703-481-8160
Mailing Address - Fax:
Practice Address - Street 1:13525 DULLES TECHNOLOGY DR
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-3413
Practice Address - Country:US
Practice Address - Phone:703-481-8160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168933363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily