Individual
THERESA HENRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BACHLELOR
Contact information
Practice address
1275 WALTER ST # SR, ALPENA, MI 49707-8113
(989) 464-5224
Mailing address
1275 WALTER ST, ALPENA, MI 49707-8113
(989) 464-5224
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
H560792067962
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
247200000X
247200000X/TECHNICAN-OTHER
MI
Enumeration date
08/19/2016
Last updated
08/19/2016
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