Provider Demographics
NPI:1982937488
Name:HENRY, BEATRICE JOY
Entity Type:Individual
Prefix:
First Name:BEATRICE
Middle Name:JOY
Last Name:HENRY
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 1:511 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44813-8968
Mailing Address - Country:US
Mailing Address - Phone:419-512-6555
Mailing Address - Fax:419-886-3201
Practice Address - Street 1:511 MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLVILLE
Practice Address - State:OH
Practice Address - Zip Code:44813-8968
Practice Address - Country:US
Practice Address - Phone:419-512-6555
Practice Address - Fax:419-886-3201
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN110392164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse