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General NPI Number Information
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NPI Number | 1528976594
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Entity Type | Individual
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Provider Name | ANGELA ROSHAWN HENRY NP
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Gender | Female
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Dates
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Enumeration Date | 08/31/2026
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Last Update Date | 08/31/2026
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Provider Practice Location Address
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Address Line | 2 SAINT MARKS PL STE 110
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City | LA GRANGE
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State | TX
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Zip | 78945-1255
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Country | US
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Telephone | 979-968-8493
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Fax | 979-968-6388
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Provider Business Mailing Address
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Address Line | 2 SAINT MARKS PL STE 110
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City | LA GRANGE
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State | TX
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Zip | 78945-1255
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Country | US
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Telephone | 979-968-8493
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Fax | 979-968-6388
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1035322
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License Number State | TX
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