Individual
BRENDA G. HENSLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
4605 MACCORKLE AVE SW, SOUTH CHARLESTON, WV 25309-1311
(304) 766-3600
Mailing address
331 LAIDLEY ST, SUITE 606, CHARLESTON, WV 25301-1619
(304) 344-0096
(304) 342-4725
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
047230
WV
367500000X
Certified Registered Nurse Anesthetist
05000
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001720710
WV BLUE CROSS PROVIDER #
WV
05
—
0069102000
—
WV
01
—
550696369
WV WORKERS PROVIDER #
WV
Enumeration date
07/27/2006
Last updated
09/23/2011
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