Provider Demographics
NPI:1639901325
Name:MCHENRY, TORI JEAN (RN)
Entity type:Individual
Prefix:
First Name:TORI
Middle Name:JEAN
Last Name:MCHENRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TORI
Other - Middle Name:JEAN
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:516 PONTILLO DR
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007-9713
Mailing Address - Country:US
Mailing Address - Phone:303-908-5001
Mailing Address - Fax:
Practice Address - Street 1:2360 E PERSHING BLVD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-5356
Practice Address - Country:US
Practice Address - Phone:307-778-7550
Practice Address - Fax:307-778-7328
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY46992163WX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0800XNursing Service ProvidersRegistered NurseOrthopedic