MEDICARE: MRS. FERN O MCHENRY NP

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	363L00000X	Nurse Practitioner	71000956A	IN
2	363LF0000X	Family Nurse Practitioner	71000956A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932201175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. FERN O MCHENRY NP

Provider Business Mailing Address
First Line	:	PO BOX 392552
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15251-9500
Country	:	US
Telephone Number	:	260-483-9081
Fax Number	:	260-483-9196

Provider Business Practice Location Address
First Line	:	3512 STELLHORN RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-4631
Country	:	US
Telephone Number	:	260-483-9081
Fax Number	:	260-483-9196

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

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	09/19/2019

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