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NPI Code Detail

MEDICARE: KATRINA HELENE HENRY RN, BSN, PHN

MEDICARE: KATRINA HELENE HENRY RN, BSN, PHN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WC1500XCommunity Health Registered Nurse583853CA

General Provider Information

NPI Number : 1912124157
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATRINA HELENE HENRY RN, BSN, PHN
Provider Business Mailing Address
First Line : 5730 PACKARD AVE STE 100
Second Line :
City : MARYSVILLE
State : CA
Zip : 95901-7117
Country : US
Telephone Number : 530-749-6393
Fax Number : 530-749-6397
Provider Business Practice Location Address
First Line : 5730 PACKARD AVE STE 100
Second Line :
City : MARYSVILLE
State : CA
Zip : 95901-7117
Country : US
Telephone Number : 530-749-6393
Fax Number : 530-749-6397
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2007
Last Update Date : 02/22/2026

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