Provider Demographics
NPI:1962166413
Name:HENRY, JOSSETH A (LPN)
Entity type:Individual
Prefix:MISS
First Name:JOSSETH
Middle Name:A
Last Name:HENRY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:762 SAINT MARKS AVE APT 4D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-3723
Mailing Address - Country:US
Mailing Address - Phone:646-250-3417
Mailing Address - Fax:
Practice Address - Street 1:762 SAINT MARKS AVE APT 4D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-3723
Practice Address - Country:US
Practice Address - Phone:646-250-3417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342832164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse