Provider Demographics
NPI:1386716504
Name:HENAGER, HELENE PATRICIA (NP)
Entity type:Individual
Prefix:
First Name:HELENE
Middle Name:PATRICIA
Last Name:HENAGER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9356 E RITA RD
Mailing Address - Street 2:STE 140
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-6315
Mailing Address - Country:US
Mailing Address - Phone:520-398-7079
Mailing Address - Fax:520-207-4317
Practice Address - Street 1:9356 E RITA RD
Practice Address - Street 2:STE 140
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-6315
Practice Address - Country:US
Practice Address - Phone:520-398-7079
Practice Address - Fax:520-207-4317
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16506363L00000X
AZ147409363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ830364Medicaid
AZZ196461Medicare PIN