Provider Demographics
NPI:1902092265
Name:HENSON, CHRISTINE MARGARET (RN BSN)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:MARGARET
Last Name:HENSON
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 8TH AVE S
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-3359
Mailing Address - Country:US
Mailing Address - Phone:608-792-6656
Mailing Address - Fax:
Practice Address - Street 1:609 8TH AVE S
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-3359
Practice Address - Country:US
Practice Address - Phone:608-792-6656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI96166-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39851000Medicaid