Provider Demographics
NPI:1952707341
Name:HENRI, MARIE-ANTOINETTE
Entity type:Individual
Prefix:
First Name:MARIE-ANTOINETTE
Middle Name:
Last Name:HENRI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8660 208TH ST
Mailing Address - Street 2:3D
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11427-1615
Mailing Address - Country:US
Mailing Address - Phone:516-305-1825
Mailing Address - Fax:718-217-2185
Practice Address - Street 1:8660 208TH ST
Practice Address - Street 2:3D
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-1615
Practice Address - Country:US
Practice Address - Phone:516-305-1825
Practice Address - Fax:718-217-2185
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-12
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317977164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse