Individual
DIANE M HENRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
210 1ST ST N, BOX 67, BERTHA, MN 56437-0067
(218) 924-2250
(218) 924-2257
Mailing address
1771 COUNTY ROAD 120 NE, ALEXANDRIA, MN 56308-8009
(320) 846-8171
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
9263
MN
Other
Enumeration date
09/14/2005
Last updated
09/11/2007
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