Provider Demographics
NPI:1699247411
Name:HENZLER, JESSICA ERIN (RN,BSN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ERIN
Last Name:HENZLER
Suffix:
Gender:F
Credentials:RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 TACOMA AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-2335
Mailing Address - Country:US
Mailing Address - Phone:716-816-4065
Mailing Address - Fax:716-871-6040
Practice Address - Street 1:140 TACOMA AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216-2335
Practice Address - Country:US
Practice Address - Phone:716-816-4065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY616766163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool