Provider Demographics
NPI:1144627894
Name:HENRI, LUDNER SR (CNA212386)
Entity type:Individual
Prefix:MR
First Name:LUDNER
Middle Name:
Last Name:HENRI
Suffix:SR
Gender:M
Credentials:CNA212386
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 SW DURHAM TER
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-1547
Mailing Address - Country:US
Mailing Address - Phone:832-289-3730
Mailing Address - Fax:772-618-6561
Practice Address - Street 1:841 SW DURHAM TERR
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953
Practice Address - Country:US
Practice Address - Phone:832-289-3730
Practice Address - Fax:772-618-6561
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA212386376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide