Healthcare Provider Details

I. General information

NPI: 1669331179
Provider Name (Legal Business Name): STARLA DAWN HENSON MSN, AGCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2026
Last Update Date: 09/23/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9610 N. CENTENNIAL DR. STE F
MUNSTER IN
46321
US

IV. Provider business mailing address

JEM MEDSPA INDIANA 9610 N. CENTENNIAL DR. STE F
MUNSTER IN
46321
US

V. Phone/Fax

Practice location:
  • Phone: 219-249-0777
  • Fax:
Mailing address:
  • Phone: 219-249-0777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number71017498A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: