Healthcare Provider Details

I. General information

NPI: 1124010350
Provider Name (Legal Business Name): ANNE E HENLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 LOGAN ST STE 100
NOBLESVILLE IN
46060-1557
US

IV. Provider business mailing address

341 LOGAN ST STE 100
NOBLESVILLE IN
46060-1557
US

V. Phone/Fax

Practice location:
  • Phone: 317-773-5555
  • Fax: 317-773-6200
Mailing address:
  • Phone: 317-773-5555
  • Fax: 317-773-6200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number01032800A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: