Provider Demographics
NPI:1275335358
Name:HENRY, JUSTIN ROBERT (RN)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:ROBERT
Last Name:HENRY
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1848 ALLAN ST
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-4460
Mailing Address - Country:US
Mailing Address - Phone:517-918-2456
Mailing Address - Fax:
Practice Address - Street 1:1325 N MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1721
Practice Address - Country:US
Practice Address - Phone:517-273-3210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704358909163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse