Healthcare Provider Details

I. General information

NPI: 1689523599
Provider Name (Legal Business Name): VANESSA Q HENRY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2026
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E INDIAN SCHOOL RD
PHOENIX AZ
85012-1892
US

IV. Provider business mailing address

5141 W WINDROSE DR
GLENDALE AZ
85304-1943
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-5551
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number222652
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: