Basic Information
| Provider Information | |||||||||
| NPI: | 1750520995 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HENRY | ||||||||
| FirstName: | CASSEL | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | LVN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 38647 25TH ST E UNIT 3 | ||||||||
| Address2: | |||||||||
| City: | PALMDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935504186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612734609 | ||||||||
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| Practice Location | |||||||||
| Address1: | 506 JACKMAN ST | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6617262850 | ||||||||
| FaxNumber: | 6617262854 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2009 | ||||||||
| LastUpdateDate: | 02/11/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | VN222648 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.