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General NPI Number Information
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NPI Number | 1194416297
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Entity Type | Individual
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Provider Name | KOLEA TWAYETTE HENRY
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Gender | Female
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Dates
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Enumeration Date | 05/18/2023
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | PO BOX 14335
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City | IRVINE
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State | CA
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Zip | 92623-4335
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Country | US
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Telephone | 941-993-3569
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Fax | 323-693-7157
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Provider Business Mailing Address
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Address Line | PO BOX 14335
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City | IRVINE
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State | CA
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Zip | 92623-4335
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Country | US
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Telephone | 941-993-3569
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Fax | 323-693-7157
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 95146429
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License Number State | CA
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