Provider Demographics
NPI:1386886513
Name:HENSHAW, MARY ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:HENSHAW
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3400 W WHEATLAND RD
Mailing Address - Street 2:PAV III STE#360
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-4418
Mailing Address - Country:US
Mailing Address - Phone:214-884-4700
Mailing Address - Fax:214-884-4749
Practice Address - Street 1:7979 W VIRGINIA DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3798
Practice Address - Country:US
Practice Address - Phone:972-780-8400
Practice Address - Fax:972-296-0105
Is Sole Proprietor?:No
Enumeration Date:2009-04-02
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06174363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB154533Medicare PIN
TXTXB154534Medicare PIN
TXTXB154535Medicare PIN