Provider Demographics
NPI:1447485776
Name:HENRICH, TERRI JO (LPN)
Entity type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:JO
Last Name:HENRICH
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 1:5170 STATE ROUTE 31 APARTMENT 2
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:NY
Mailing Address - Zip Code:13041
Mailing Address - Country:US
Mailing Address - Phone:315-657-8272
Mailing Address - Fax:
Practice Address - Street 1:5170 STATE ROUTE 31 APARTMENT 2
Practice Address - Street 2:
Practice Address - City:CLAY
Practice Address - State:NY
Practice Address - Zip Code:13041
Practice Address - Country:US
Practice Address - Phone:315-657-8272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239656-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse