Provider Demographics
NPI:1598504094
Name:HENRY, LYNZORA
Entity type:Individual
Prefix:
First Name:LYNZORA
Middle Name:
Last Name:HENRY
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 1:6614 BLUE DIAMOND RD UNIT 1015
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-7309
Mailing Address - Country:US
Mailing Address - Phone:725-760-7867
Mailing Address - Fax:
Practice Address - Street 1:6614 BLUE DIAMOND RD UNIT 1015
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-7309
Practice Address - Country:US
Practice Address - Phone:725-760-7867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant