Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207NS0135X | Procedural Dermatology | 044232 | GA |
Y | 207NS0135X | Procedural Dermatology | ME79598 | FL |
NPI | 1134183718 |
---|---|
Provider Name | Cynthia D Hensley |
First Address | Bonita Springs, FL 34135 |
Second Address | Bonita Springs, FL 34135 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2006 |
Last Update Date | 03/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
070014768 | RAILROAD MEDICARE (01) | FL |
35789 | BLUE CROSS BLUE SHIELD FL (01) | FL |
H14043 | (02) | FL |