Provider Demographics
NPI:1285257840
Name:HENLEY, VANESSA M
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:M
Last Name:HENLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8031 PANDORA STAR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78252-4447
Mailing Address - Country:US
Mailing Address - Phone:210-524-7747
Mailing Address - Fax:
Practice Address - Street 1:8000 W IH 10 STE 1500
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-3883
Practice Address - Country:US
Practice Address - Phone:210-524-7747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty