Provider Demographics
NPI:1861946816
Name:HENZE-NELSON, BRENDA
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:HENZE-NELSON
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 1:710 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4455
Mailing Address - Country:US
Mailing Address - Phone:907-452-4222
Mailing Address - Fax:907-452-8176
Practice Address - Street 1:710 3RD AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4455
Practice Address - Country:US
Practice Address - Phone:907-452-4222
Practice Address - Fax:907-452-8176
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)