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General NPI Number Information
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NPI Number | 1124280953
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Entity Type | Individual
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Provider Name | HEATHER HENSLEY D.O.
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Gender | Female
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Dates
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Enumeration Date | 07/02/2008
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Last Update Date | 12/27/2024
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Provider Practice Location Address
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Address Line | 2501 E SOUTHERN AVE STE 18
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City | TEMPE
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State | AZ
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Zip | 85282-7667
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Country | US
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Telephone | 480-830-8333
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Fax |
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Provider Business Mailing Address
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Address Line | 2250 W SOUTHERN AVE STE 102
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City | MESA
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State | AZ
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Zip | 85202-4736
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Country | US
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Telephone | 480-830-8333
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 83764
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 011291
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License Number State | AZ
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