Provider Demographics
NPI:1306847686
Name:HENSON, ELAINE RUTH (ANP)
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:RUTH
Last Name:HENSON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:MRS
Other - First Name:ELAINE
Other - Middle Name:RUTH
Other - Last Name:BROSIOUS-HENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:4264 FEATHER AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-5531
Mailing Address - Country:US
Mailing Address - Phone:928-208-0206
Mailing Address - Fax:
Practice Address - Street 1:15333 N PIMA RD STE 305
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2717
Practice Address - Country:US
Practice Address - Phone:887-318-9948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZNP54363L00000X
CA16376363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ500000021OtherRAILROAD MEDICARE
AZ333253Medicaid
AZAZ0153580OtherBLUE CROSS BLUE SHIELD
AZ333253Medicaid
AZ333253Medicaid