=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669331179
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STARLA D. HENSON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2026
-----------------------------------------------------
Last Update Date | 01/20/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14785 W 101ST AVE STE 205
-----------------------------------------------------
City | DYER
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46311-3371
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-319-5434
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10746 KEYSTONE LN
-----------------------------------------------------
City | CROWN POINT
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46307-8004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-969-2054
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 364S00000X
-----------------------------------------------------
Taxonomy Name | Clinical Nurse Specialist
-----------------------------------------------------
License Number | 71017498A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------