Provider Demographics
NPI:1124308523
Name:MARQUIS HENSON, CARLY A (APRN)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:A
Last Name:MARQUIS HENSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:
Other - Last Name:MARQUIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-7559
Mailing Address - Country:US
Mailing Address - Phone:603-225-0123
Mailing Address - Fax:603-227-7591
Practice Address - Street 1:250 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-7539
Practice Address - Country:US
Practice Address - Phone:603-225-0123
Practice Address - Fax:603-227-7591
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28185426A363LA2200X
NH073463-23363LA2200X
MI4704309057363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner