Healthcare Provider Details

I. General information

NPI: 1629354469
Provider Name (Legal Business Name): DEBRA L HENRY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2011
Last Update Date: 09/29/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 N MAIN ST
MAYFIELD NY
12117-4019
US

IV. Provider business mailing address

16 2ND AVE
MAYFIELD NY
12117-3997
US

V. Phone/Fax

Practice location:
  • Phone: 518-661-5352
  • Fax:
Mailing address:
  • Phone: 518-661-5352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number455155
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: