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Individual

MRS. ELAINE RUTH HENSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ANP

Contact information

Practice address
15333 N PIMA RD STE 305, SCOTTSDALE, AZ 85260-2717
(887) 318-9948
Mailing address
4264 FEATHER AVE, SAN DIEGO, CA 92117-5531
(928) 208-0206

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
AZNP54
AZ
363LA2200X
Adult Health Nurse Practitioner
Primary
16376
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
333253
AZ
01
500000021
RAILROAD MEDICARE
AZ
01
AZ0153580
BLUE CROSS BLUE SHIELD
AZ
Enumeration date
08/09/2005
Last updated
06/24/2024
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