Provider Demographics
NPI:1386471621
Name:HENARY, MARINA
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:HENARY
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 1:1199 N BROADWAY ST APT 244
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-0015
Mailing Address - Country:US
Mailing Address - Phone:817-319-4947
Mailing Address - Fax:
Practice Address - Street 1:6221 CHAPEL HILL BLVD STE 300
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4750
Practice Address - Country:US
Practice Address - Phone:469-409-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1175624363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health