Provider Demographics
NPI:1063258911
Name:HENRY, BRITTANY MICHELLE (APRN)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:MICHELLE
Last Name:HENRY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 W LAKE AVE APT B108
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1489
Mailing Address - Country:US
Mailing Address - Phone:224-217-0598
Mailing Address - Fax:
Practice Address - Street 1:4300 W LAKE AVE APT B108
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1489
Practice Address - Country:US
Practice Address - Phone:224-217-0598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041407075163W00000X
IL209029965363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse