1013232206 NPI number — DEBRA LYNN HENN PT

Table of content: DEBRA LYNN HENN PT (NPI 1013232206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013232206 NPI number — DEBRA LYNN HENN PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENN
Provider First Name:
DEBRA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013232206
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2874 N CARSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARSON CITY
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89706-0251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-883-4161
Provider Business Mailing Address Fax Number:
775-883-7742

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 PENNY LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATSONVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95076-3079
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-786-9000
Provider Business Practice Location Address Fax Number:
831-786-9100
Provider Enumeration Date:
03/31/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT20496 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PT20496 . This is a "LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".