Provider Information for 1104535095
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LAKEISHA DANIELLE HENRY
Sex: Female
NPI: 1104535095
Last Updated: 2022-11-18
Certification Date: 2022-11-18
Certification Date: 2022-11-18
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1104535095 | ||||||||
| Enumeration Date | 2022-11-18 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 4505 BILTMORE DR NW ROANOKE, VA 24017-1513 United States Phone: 540-491-1552 | Fax: | ||||||||
| Primary Practice Address | 4505 BILTMORE DR NW ROANOKE, VA 24017-1513 United States Phone: 540-491-1552 | Fax: | ||||||||
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