=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700330842
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDWARD HENSON APRN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2016
-----------------------------------------------------
Last Update Date | 08/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1876 DOCTOR ANDRES WAY STE 83
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33445-4676
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-634-1354
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 304 S JONES BLVD # 7002
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89107-2623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-882-5448
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | APRN002229
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------