Provider Demographics
NPI:1902404783
Name:HENRY, DENISE M
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:M
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 1:3524 KODIAK ST NW APT 203
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-8634
Mailing Address - Country:US
Mailing Address - Phone:701-720-0714
Mailing Address - Fax:
Practice Address - Street 1:3524 KODIAK ST NW APT 203
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-8634
Practice Address - Country:US
Practice Address - Phone:701-720-0714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant