Individual
THERESE HENRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1911 COOKS HILL RD, CENTRALIA, WA 98531-9073
(360) 736-6778
(360) 736-6552
Mailing address
305 N 1100 E, ZIONSVILLE, IN 46077-9756
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
28193241A
IN
363LP0200X
Pediatric Nurse Practitioner
Primary
AP60911627
WA
Other
Enumeration date
09/08/2017
Last updated
01/26/2019
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