Provider Demographics
NPI:1871776674
Name:WEBB, HENRIETTA JANE
Entity type:Individual
Prefix:MS
First Name:HENRIETTA
Middle Name:JANE
Last Name:WEBB
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:HENRIETTA
Other - Middle Name:JANE
Other - Last Name:FOGT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:91-1476 RENTON RD
Mailing Address - Street 2:UNIT #7
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-4220
Mailing Address - Country:US
Mailing Address - Phone:808-384-5712
Mailing Address - Fax:
Practice Address - Street 1:91-1476 RENTON RD
Practice Address - Street 2:UNIT #7
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-4220
Practice Address - Country:US
Practice Address - Phone:808-384-5712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRRN 51984163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse