Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | ME131549 | FL |
NPI | 1255438636 |
---|---|
Provider Name | Melinda B Henne |
First Address | Jacksonville, FL 32245-6568 |
Second Address | Jacksonville, FL 32258 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 19/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020761500 | (05) | FL |
K0UWU | BCBS (01) | FL |