Provider Demographics
NPI:1093241010
Name:HENRY, MARINETE (NP)
Entity type:Individual
Prefix:MRS
First Name:MARINETE
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 TURNPIKE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-6122
Mailing Address - Country:US
Mailing Address - Phone:978-401-4444
Mailing Address - Fax:978-209-2808
Practice Address - Street 1:805 TURNPIKE ST STE 101
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-6122
Practice Address - Country:US
Practice Address - Phone:978-401-4444
Practice Address - Fax:978-209-2808
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN264251163WP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health