Healthcare Provider Details

I. General information

NPI: 1306491287
Provider Name (Legal Business Name): JANNA ROSE HENKEL RN, PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2019
Last Update Date: 08/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 W 15TH ST STE 1025
PLANO TX
75075-7253
US

IV. Provider business mailing address

1255 W 15TH ST STE 1025
PLANO TX
75075-7253
US

V. Phone/Fax

Practice location:
  • Phone: 972-673-0404
  • Fax: 469-626-9670
Mailing address:
  • Phone: 972-673-0404
  • Fax: 469-626-9670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number221150
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2475275
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: