Provider Demographics
NPI:1679206502
Name:HENSLEY, NICOLE (LVN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6005 FM 1840
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:TX
Mailing Address - Zip Code:75570-5516
Mailing Address - Country:US
Mailing Address - Phone:903-278-3581
Mailing Address - Fax:
Practice Address - Street 1:6005 FM 1840
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:TX
Practice Address - Zip Code:75570-5516
Practice Address - Country:US
Practice Address - Phone:903-278-3581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX345211164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse