Basic Information
| Provider Information | |||||||||
| NPI: | 1912170424 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HENSLEY | ||||||||
| FirstName: | MARTHA | ||||||||
| MiddleName: | MAE | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | RR 2 BOX 435 | ||||||||
| Address2: | |||||||||
| City: | PENNINGTON GAP | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242779645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2765461027 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1990 HOLTON AVE. EAST | ||||||||
| Address2: | |||||||||
| City: | BIG STONE GAP | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2765233111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2008 | ||||||||
| LastUpdateDate: | 08/20/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 0001106926 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.