Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | RN67983 | ME |
NPI | 1366071441 |
---|---|
Provider Name | Joshua Stephen Henke |
First Address | Portland, ME 04103-5017 |
Second Address | Portland, ME 04102-3134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2020 |
Last Update Date | 02/04/2020 |