Healthcare Provider Details

I. General information

NPI: 1134052483
Provider Name (Legal Business Name): ANNA HENRY AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TRESSEL WAY
YOUNGSTOWN OH
44555-9703
US

IV. Provider business mailing address

1717 MATHEWS RD
YOUNGSTOWN OH
44514-1457
US

V. Phone/Fax

Practice location:
  • Phone: 330-941-3000
  • Fax:
Mailing address:
  • Phone: 330-402-9768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.480155
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: