MEDICARE: MRS. STACI LYNN HENSHAW PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	26NJ15158200	NJ

General Provider Information

NPI Number	:	1184441057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STACI LYNN HENSHAW PMHNP

Provider Business Mailing Address
First Line	:	414 W PLEASANT ST
Second Line	:
City	:	HAMMONTON
State	:	NJ
Zip	:	08037-1347
Country	:	US
Telephone Number	:	609-957-0368
Fax Number	:

Provider Business Practice Location Address
First Line	:	165 PASSAIC AVE STE 200
Second Line	:
City	:	FAIRFIELD
State	:	NJ
Zip	:	07004-3526
Country	:	US
Telephone Number	:	800-413-8020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2024
Last Update Date	:	06/17/2026

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