Individual
MR. NICHOLAS HENSLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MPAS, PA-C
Contact information
Practice address
3155 CHANNING WAY STE B, IDAHO FALLS, ID 83404-7534
(208) 535-4800
(208) 535-4807
Mailing address
3155 CHANNING WAY STE B, IDAHO FALLS, ID 83404-7534
(208) 535-4800
(208) 535-4807
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA-1410
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002786100
—
ID
Enumeration date
09/15/2016
Last updated
09/15/2016
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