Healthcare Provider Details

I. General information

NPI: 1275398554
Provider Name (Legal Business Name): MARSHALEE HENRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARSHALEE HENRY-BLAIR

II. Dates (important events)

Enumeration Date: 02/16/2024
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 ALBANY AVE
HARTFORD CT
06120-2508
US

IV. Provider business mailing address

500 ALBANY AVE
HARTFORD CT
06120-2508
US

V. Phone/Fax

Practice location:
  • Phone: 860-249-9625
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number906816
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number914540
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10.228774
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number12.014373
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: