Doctor Name: | PATRICIA WYNN HENMAN |
NPI Number: | 1730361445 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | 2521 |
Business Practice Address: | 315 Park Ave Fort Lupton, CO - 806211929 |
Business Phone Number: | 3038576111 |
Business Fax Number: | |
Mailing Address: | 315 Park Ave, FORT LUPTON |
State: | CO |
Postal Code: | 806211929 |
Phone Number: | 3038576111 |
Fax Number: | |
NPI Enumeration Date: | 12/04/2007 |
NPI Last Update Date: | 12/04/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 2521 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |