Provider Demographics
NPI:1366324188
Name:HENTHORNE, ANDREA LAVON (ODA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LAVON
Last Name:HENTHORNE
Suffix:
Gender:F
Credentials:ODA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 N MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:PAYNE
Mailing Address - State:OH
Mailing Address - Zip Code:45880-9070
Mailing Address - Country:US
Mailing Address - Phone:419-233-9027
Mailing Address - Fax:419-233-9027
Practice Address - Street 1:107 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:PAYNE
Practice Address - State:OH
Practice Address - Zip Code:45880-9070
Practice Address - Country:US
Practice Address - Phone:419-233-9027
Practice Address - Fax:419-233-9027
Is Sole Proprietor?:No
Enumeration Date:2025-07-23
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant