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Individual
NICOLE LYNN HENN
Active
Individual
NICOLE LYNN HENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1454
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10026139600
—
NE
01
—
1454
PHYSICIAN ASSISTANT LICENSE
NE
Enumeration date
07/14/2009
Last updated
03/24/2021
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