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General NPI Number Information
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NPI Number | 1790264828
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Entity Type | Individual
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Provider Name | ELIZA JOAN HENLEY NP
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Gender | Female
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Dates
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Enumeration Date | 08/09/2018
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Last Update Date | 02/12/2021
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Provider Practice Location Address
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Address Line | 47 CONGRESS STREET SALEM FAMILY HEALTH CENTER
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City | SALEM
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State | MA
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Zip | 01970
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Country | US
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Telephone | 978-744-8388
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Fax | 978-740-2339
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Provider Business Mailing Address
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Address Line | 27 CONGRESS ST STE 513
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City | SALEM
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State | MA
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Zip | 01970-5523
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Country | US
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Telephone | 978-744-8388
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71008213A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN2306004
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License Number State | MA
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