Healthcare Provider Details

I. General information

NPI: 1447231642
Provider Name (Legal Business Name): ANN LOUISE HENELT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 05/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 BERTHA HOWE AVE SUITE 8
MESQUITE NV
89027-7502
US

IV. Provider business mailing address

1301 BERTHA HOWE AVE SUITE 8
MESQUITE NV
89027-7502
US

V. Phone/Fax

Practice location:
  • Phone: 702-346-1700
  • Fax: 702-346-3563
Mailing address:
  • Phone: 702-346-1700
  • Fax: 702-346-3563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberAH010464
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberDO1535
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: