Individual
JACKSON HENLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
820 N CHELAN AVE, WENATCHEE, WA 98801-2028
(509) 663-8711
Mailing address
820 N CHELAN AVE, WENATCHEE, WA 98801-2028
(509) 663-8711
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD60451402
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578854899
—
WA
01
—
P01419754
RR PTAN CWH
WA
Enumeration date
04/20/2011
Last updated
03/28/2018
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