Individual
JACQUELINE LEE HENRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-NP
Contact information
Practice address
6301 UNIVERSITY COMMONS, SOUTH BEND, IN 46635-1571
(574) 251-1210
Mailing address
6301 UNIVERSITY COMMONS, SOUTH BEND, IN 46635-1571
(574) 251-2100
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28301774A
IN
363L00000X
Nurse Practitioner
10033768
OR
363LF0000X
Family Nurse Practitioner
Primary
10033768
OR
Other
Enumeration date
09/24/2024
Last updated
05/26/2026
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