Individual
CYNTHIA JEAN HENRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
2817 NEW PINERY RD, PORTAGE, WI 53901-9240
(608) 742-4131
Mailing address
2817 NEW PINERY RD, PORTAGE, WI 53901-9240
(608) 742-4131
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
44416
WI
208000000X
Pediatrics Physician
5101014794
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3552210244
BLUE CROSS PIN
MI
05
—
43506900
—
WI
Enumeration date
06/08/2006
Last updated
11/17/2022
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