Healthcare Provider Details

I. General information

NPI: 1851884456
Provider Name (Legal Business Name): DIONNE HUTSON HENDY DNP, MSN-AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2018
Last Update Date: 08/18/2024
Certification Date: 08/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 VALLEY RD # 148
MONTCLAIR NJ
07042-2709
US

IV. Provider business mailing address

PO BOX 639295
CINCINNATI OH
45263-9295
US

V. Phone/Fax

Practice location:
  • Phone: 973-559-4600
  • Fax:
Mailing address:
  • Phone: 248-266-4200
  • Fax: 855-618-6655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number307111
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number26NJ01439000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: