Provider Demographics
NPI:1730704834
Name:HENSLEY, WINSTON MILLER III
Entity type:Individual
Prefix:
First Name:WINSTON
Middle Name:MILLER
Last Name:HENSLEY
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1948 CHARLA LEE LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-2636
Mailing Address - Country:US
Mailing Address - Phone:757-372-2841
Mailing Address - Fax:
Practice Address - Street 1:1948 CHARLA LEE LN
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-2636
Practice Address - Country:US
Practice Address - Phone:757-372-2841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT25038451172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver