Provider Demographics
NPI:1285906651
Name:HENRY, VANESSA LYNN (RN, IBCLC, RNFA)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:LYNN
Last Name:HENRY
Suffix:
Gender:F
Credentials:RN, IBCLC, RNFA
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:LYNN
Other - Last Name:BOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14089 W CHARTER OAK RD
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-5511
Mailing Address - Country:US
Mailing Address - Phone:623-330-3646
Mailing Address - Fax:
Practice Address - Street 1:14089 W CHARTER OAK RD
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-5511
Practice Address - Country:US
Practice Address - Phone:623-330-3646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-01
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10961014163WL0100X
AZRN114974163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant