Healthcare Provider Details

I. General information

NPI: 1245179043
Provider Name (Legal Business Name): VIRGINIA HENRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 E MANZANITA PL
PHOENIX AZ
85020-3666
US

IV. Provider business mailing address

617 E MANZANITA PL
PHOENIX AZ
85020-3666
US

V. Phone/Fax

Practice location:
  • Phone: 669-238-5805
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number226753
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: