Provider Demographics
NPI:1104586288
Name:HENTHORNE, JUVY DE LA CERNA (RN)
Entity type:Individual
Prefix:
First Name:JUVY
Middle Name:DE LA CERNA
Last Name:HENTHORNE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3524 DAVIESHIRE DR
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-0901
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3524 DAVIESHIRE DR
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-0901
Practice Address - Country:US
Practice Address - Phone:631-804-8637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY757827163WC3500X, 163WM0705X
TN250557163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No163WC3500XNursing Service ProvidersRegistered NurseCardiac Rehabilitation
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical