Provider Demographics
NPI:1104624592
Name:HENRIKSEN, DEBANY
Entity type:Individual
Prefix:
First Name:DEBANY
Middle Name:
Last Name:HENRIKSEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 S 200 E
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:UT
Mailing Address - Zip Code:84653-9412
Mailing Address - Country:US
Mailing Address - Phone:801-360-3902
Mailing Address - Fax:
Practice Address - Street 1:247 S 200 E
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:UT
Practice Address - Zip Code:84653-9412
Practice Address - Country:US
Practice Address - Phone:801-360-3902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTUT013162501232374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide